Osteoporosis Risk Assessment Research Articles

The impact of fragility fracture and approaches to osteoporosis risk assessment worldwide

Osteoporosis constitutes a major public health problem, through its association with age-related fractures, particularly of the hip, vertebrae, distal forearm and humerus. Substantial geographic variation has been noted in the incidence of osteoporotic fractures worldwide, with Western populations (North America, Europe and Oceania), reporting increases in hip fracture throughout the second half of the 20th century, with a stabilisation or decline in the last two decades. In developing populations however, particularly in Asia, the rates of osteoporotic fracture appears to be increasing. The massive global burden consequent to osteoporosis means that fracture risk assessment should be a high priority among health measures considered by policy makers.The WHO operational definition of osteoporosis, based on a measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), has been used globally since the mid-1990s. However, although this definition identifies those at greatest individual risk of fracture, in the population overall a greater total number of fractures occur in individuals with BMD values above the threshold for osteoporosis diagnosis. A number of web-based tools to enable the inclusion of clinical risk factors, with or without BMD, in fracture prediction algorithms have been developed to improve the identification of individuals at high fracture risk, the most commonly used globally being FRAX®. Access to DXA, osteoporosis risk assessment, case finding and treatment varies worldwide, but despite such advances studies indicate that a minority of men and women at high fracture risk receive treatment. Importantly, research is ongoing to demonstrate the clinical efficacy and cost-effectiveness of osteoporosis case finding and risk assessment strategies worldwide. The huge burden caused by osteoporosis related fractures to individuals, healthcare systems and societies should provide a clear impetus for the progression of such approaches.

Correlation of Estradiol Serum Levels with Classification of Osteoporosis Risk OSTA (Osteoporosis Self-Assessment Tools for Asian) in Menopause Women

Background: In postmenopausal women, decreasing estrogen levels is a marker of ovarian dysfunction. Hypoestrogenic state has known increasing the risk of osteoporosis. Objective: To determine the correlation between estradiol serum levels with classification of osteoporosis risk OSTA (Osteoporosis Self-Assessment Tools for Asian) in menopausal women. Methods: This study was case series study which examined estradiol serum in menopausal women by ELISA and assess the osteoporosis risk using osteoporosis risk classification OSTA. Total 47 samples was collected at Dr. H.Adam malik, dr. Pirngadi, and RSU Networking in Medan. This research was conducted from May to December 2016. Data were statistically analyzed, and presented with Spearman test. Results: In this study, we found the mean levels of estradiol in menopausal women was 18.62 ± 16.85 ng / ml with OSTA osteoporosis risk score of 2.09 ± 2.45. There was a significant positive correlation between estradiol and risk of osteoporosis OSTA with correlation coefficient r = 0.825 and p <0.05. Conclusion: There is a strong positive correlation between serum levels of estradiol with OSTA osteoporosis risk assessment in menopausal women.

Risk assessment of osteoporosis in pre- and postmenopausal periodontally healthy and chronic periodontitis women with digital panoramic radiographs.

Background:Osteoporosis is particularly high in females, the early identification of which remains a challenge. Panoramic radiographs are routinely advised to detect periodontal diseases and can be used to predict low bone mineral density (BMD). Hence, this investigation was aimed to identify the risk of osteoporosis in pre- and postmenopausal periodontally healthy and chronic periodontitis women with digital panoramic radiographs.Materials and Methods:The study population consisted of 120 patients equally divided as Group I - Premenopausal periodontally healthy, Group II - Premenopausal periodontitis, Group III - Postmenopausal periodontally healthy, and Group IV - Postmenopausal periodontitis. Clinical parameters were recorded, and digital panoramic radiographs were used to record the mental index (MI), panoramic mandibular index (PMI), and mandibular cortical index (MCI) scores.Results:MI was found to be varied, and the differences were highly significant among Group III and IV (P = 0.0003) and Group II and IV (P = 0.0007), and significant difference was found between Group I and Group II (P = 0.0113). MCI evaluation showed a greater prevalence of C2 and C3 patterns among postmenopausal women. MCI correlation with MI (P < 0.0001), PMI (P < 0.0001) and age (P = 0.0029) indicated a highly significant variance.Conclusion:The positive association between MCI and chronic periodontitis in postmenopausal women confirms the high risk of osteoporosis in them. Furthermore, an increased percentage of patients with undetected decrease in BMD may be identified by screening with digital panoramic radiographs which are done on a routine basis for periodontal and other dental diseases and thus could be used as an effective aid to quantify bone density in future.

Evaluation of the validity of osteoporosis and fracture risk assessment tools (IOF One Minute Test, SCORE, and FRAX) in postmenopausal Palestinian women.

The purpose of this study is to evaluate the validity of the updated IOF (International Osteoporosis Foundation) One Minute Osteoporosis Risk Assessment Test, FRAX, SCORE as well as age alone to detect the risk of developing osteoporosis in postmenopausal Palestinian women. Three hundred eighty-two women 45years and older were recruited including 131 women with osteoporosis and 251 controls following bone mineral density (BMD) measurement, 287 completed questionnaires of the different risk assessment tools. Receiver operating characteristic (ROC) curves were evaluated for each tool using bone BMD as the gold standard for osteoporosis. The area under the ROC curve (AUC) was the highest for FRAX calculated with BMD for predicting hip fractures (0.897) followed by FRAX for major fractures (0.826) with cut-off values ˃1.5 and ˃7.8%, respectively. The IOF One Minute Test AUC (0.629) was the lowest compared to other tested tools but with sufficient accuracy for predicting the risk of developing osteoporosis with a cut-off value ˃4 total yes questions out of 18. SCORE test and age alone were also as good predictors of risk for developing osteoporosis. According to the ROC curve for age, women ≥64years had a higher risk of developing osteoporosis. Higher percentage of women with low BMD (T-score ≤-1.5) or osteoporosis (T-score ≤-2.5) was found among women who were not exposed to the sun, who had menopause before the age of 45years, or had lower body mass index (BMI) compared to controls. Women who often fall had lower BMI and approximately 27% of the recruited postmenopausal Palestinian women had accidents that caused fractures. Simple self-assessment tools like FRAX without BMD, SCORE, and the IOF One Minute Tests were valid for predicting Palestinian postmenopausal women at high risk of developing osteoporosis.

Validation of osteoporosis risk assessment tools in middle-aged Thai women

Objectives: To validate osteoporosis risk assessment tools in middle-aged Thai women.Methods: A total of 1038 women who had bone mineral density (BMD) measurements using dual-energy X-ray absorptiometry were reviewed. Clinical data were used to validate the diagnostic test performance of various osteoporosis risk assessment tools, including ABONE, FRAX®, ORAI, OSIRIS, SCORE, SOFSURF, and OSTA. The following parameters were evaluated: sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy; those with 95% confidence interval (CI) of the receiver operator characteristics area under the curve (ROC-AUC) > 0.5 were considered statistically significant.Results: The subjects had a mean age of 53.01 ± 6.20 years and body mass index (BMI) of 23.98 ± 3.38 kg/m2. Among the osteoporosis risk assessment tools being evaluated, the tools that had ROC-AUC >0.8 and 95% CI >0.5, and could predict osteoporosis at the femoral neck with high specificity of >75% and NPV of >90%, were FRAX® without BMD (ROC-AUC 0.83; 95% CI 0.73–0.93; specificity 99.90; NPV 98.89), SCORE (ROC-AUC 0.86; 95% CI 0.78–0.94; specificity 98.79; NPV 98.99), and OSTA (ROC-AUC 0.86; 95% CI 0.79–0.94; specificity 75.03; NPV 99.73).Conclusion: The prevalence of osteoporosis in the middle-aged Thai women attending Siriraj Menopause Clinic is 7.3% at the lumbar spine and/or femoral neck. FRAX® without BMD, SCORE, and OSTA have appropriate validity as tools for ruling out osteoporosis in these women.

Access to fracture risk assessment by FRAX and linked National Osteoporosis Guideline Group (NOGG) guidance in the UK-an analysis of anonymous website activity.

In the UK, guidance on assessment of osteoporosis and fracture risk is provided by the National Osteoporosis Guideline Group ( www.shef.ac.uk/NOGG ). We wished to determine access to this guidance by exploring website activity. We undertook an analysis of FRAX and NOGG website usage for the year between 1st July 2013 and 30th June 2014 using Google Analytics software. During this period, there was a total of 1,774,812 sessions (a user interaction with the website) on the FRAX website with 348,964 of these from UK-based users; 253,530 sessions were recorded on the NOGG website. Of the latter, two-thirds were returning visitors, with the vast majority (208,766; 82%) arising from sites within the UK. The remainder of sessions were from other countries demonstrating that some users of FRAX in other countries make use of the NOGG guidance. Of the UK-sourced sessions, the majority was from England, but the session rate (adjusted for population) was the highest for Scotland. Almost all (95.7%) of the UK sessions arose from calculations being passed through from the FRAX tool ( www.shef.ac.uk/FRAX ) to the NOGG website, comprising FRAX calculations in patients without a bone mineral density (BMD) measurement (74.5%) or FRAX calculations with a BMD result (21.2%). National Health Service (NHS) sites were identified as the major source of visits to the NOGG website, comprising 79.9% of the identifiable visiting locations, but this is an underestimate as many sites from within the NHS are not classified as such. The study shows that the facilitated interaction between web-based fracture risk assessment and clinical guidelines is widely used in the UK. The approach could usefully be adopted in other countries for which a FRAX model is available.

OC-078 How Good are We at Looking for Osteoporosis In Chronic Pancreatitis?

Introduction Chronic pancreatitis is a common condition managed in the outpatient setting. One of the common complications is osteoporosis and patients have double the risk of fragility fractures compared with the general population. The National Institute of Clinical Excellence (NICE) guidance recognises chronic pancreatitis as a significant risk factor and recommends that all patients aged 50 or over should be considered for DEXA scanning if they are deemed at risk. 1 The purpose of this study was to assess whether patients under review for chronic pancreatitis were being referred for DEXA scanning and to pick up the rate of fragility fractures. Methods A Single Centre, retrospective analysis of all patients identified coded as having “chronic pancreatitis” under ongoing outpatient review in a large NHS Hospital Trust in North London. We reviewed their records and imaging to assess if they had ever been referred for a DEXA scan and whether they had radiological evidence of a fragility fracture whilst under review for pancreatitis. Results Of 106 patients identified, only 1 (0.94%) was referred for DEXA scanning, which did confirm osteoporosis. This patient had been referred incidentally by a GP for another reason not pertaining to their chronic pancreatitis. 14 patients (13.21%) had sustained low impact fractures (5 hip, 3 vertebral, 3 wrist, 2 distal fibula, 1 elbow). Of these fractures 6 (42.9%) had been on no bone protection at all, 6 (42.9%) had been on calcium and vitamin D supplementation, and 2 (14.3%) had been on a bisphosphonate. Conclusion Despite chronic pancreatitis being a well-recognised risk factor for osteoporosis, the investigation and active mitigation of its risk by clinicians in the outpatient setting was poor. This may have resulted in potentially avoidable osteoporotic fractures and future studies should look at whether this is a wider phenomena nationally. We would recommend that risk assessment for osteoporosis should form a part of a routine clinical review in patients under follow up for chronic pancreatitis. Reference 1 NICE. Osteroporosis: assessing the risk of fragility fracture. NICE guidelines CG146. August 2012. Disclosure of Interest None Declared

The utility of dual-energy X-ray absorptiometry, calcaneal quantitative ultrasound, and fracture risk indices (FRAX® and Osteoporosis Risk Assessment Instrument) for the identification of women with distal forearm or hip fractures: A pilot study

ABSTRACTPurpose: Dual-energy X-ray absorptiometry (DXA) is considered the “gold standard” in predicting osteoporotic fractures. Calcaneal quantitative ultrasound (QUS) variables are also known to predict fractures. Fracture risk assessment tools may also guide us for the detection of individuals at high risk for fractures. The aim of this case–control study was to evaluate the utility of DXA bone mineral density (BMD), calcaneal QUS parameters, FRAX® (Fracture Risk Assessment Tool), and Osteoporosis Risk Assessment Instrument (ORAI) for the discrimination of women with distal forearm or hip fractures. Materials and methods: This case–control study included 20 women with a distal forearm fracture and 18 women with a hip fracture as cases and 76 age-matched women served as controls. BMD at the spine, proximal femur, and radius was measured using DXA and acoustic parameters of bone were obtained using a calcaneal QUS device. FRAX® 10-year probability of fracture and ORAI scores were also calculated in all participants. Receiver operating characteristic (ROC) analysis was used to assess fracture discriminatory power of all the tools. Results: While all DXA BMD, and QUS variables and FRAX® fracture probabilities demonstrated significant areas under the ROC curves for the discrimination of hip-fractured women and those without, only 33% radius BMD, broadband ultrasound attenuation (BUA), and FRAX® major osteoporotic fracture probability calculated without BMD showed significant discriminatory power for distal forearm fractures. Conclusions: It can be concluded that QUS variables, particularly BUA, and FRAX® major osteoporotic fracture probability without BMD are good candidates for the identification of both hip and distal forearm fractures.

Development and Validation of Osteoporosis Risk-Assessment Model for Korean Men.

PurposeThe aim of the present study was to develop an osteoporosis risk-assessment model to identify high-risk individuals among Korean men.Materials and MethodsThe study used data from 1340 and 1110 men ≥50 years who participated in the 2009 and 2010 Korean National Health and Nutrition Examination Survey, respectively, for development and validation of an osteoporosis risk-assessment model. Osteoporosis was defined as T score ≤-2.5 at either the femoral neck or lumbar spine. Performance of the candidate models and the Osteoporosis Self-assessment Tool for Asian (OSTA) was compared with sensitivity, specificity, and area under the receiver operating characteristics curve (AUC). A net reclassification improvement was further calculated to compare the developed Korean Osteoporosis Risk-Assessment Model for Men (KORAM-M) with OSTA.ResultsIn the development dataset, the prevalence of osteoporosis was 8.1%. KORAM-M, consisting of age and body weight, had a sensitivity of 90.8%, a specificity of 42.4%, and an AUC of 0.666 with a cut-off score of -9. In the validation dataset, similar results were shown: sensitivity 87.9%, specificity 39.7%, and AUC 0.638. Additionally, risk categorization with KORAM-M showed improved reclassification over that of OSTA up to 22.8%.ConclusionKORAM-M can be simply used as a pre-screening tool to identify candidates for dual energy X-ray absorptiometry tests.

Osteoporosis screening in postmenopausal women aged 50–64 years: BMI alone compared with current screening tools

ObjectivesConsensus on when to initiate DXA screening for early postmenopausal women (<65 years of age) is lacking. Low body mass index (BMI) has been proposed as one of the major risk factors for osteoporosis. This study sought to compare the predictive performance of BMI alone with 5 screening modalities (the U.S. Preventive services task force [USPSTF] FRAX threshold of 9.3%, a risk factor based approach [≥1 risk factors], the osteoporosis self-assessment tool [OST <2], the osteoporosis risk assessment instrument [ORAI ≥9], and the simple calculated osteoporosis risk estimation [SCORE ≥6]) in identifying early postmenopausal women with osteoporosis. MethodsPostmenopausal women aged 50–64 years presenting for a DXA test were recruited between January 1, 2007, and March 1, 2009. Demographic data and osteoporosis risk factors were obtained through a telephone survey. The performance of each screening tool in predicting osteoporosis was compared. ResultsOf 445 study participants, 95% were White, 38 had osteoporosis (T-score ≤−2.5). BMI (<28) was associated with the highest Sensitivity (95%), the lowest Negative Likelihood Ratio (LR-) of 0.14, an AUC of 0.73, and the number needed to scan (NNS) of 8. The USPSTF approach had the lowest sensitivity (24%), highest LR- (0.91), lowest AUC (0.62), and highest NNS (9). Among 5 established modalities, SCORE (≥6) appears to be the best (sensitivity: 92%, LR-: 0.24, AUC: 0.75, NNS: 9). ConclusionBMI (<28) had a comparable numerical screening performance overall to the current screening modalities. BMI (<28) could be considered a potential indicator when screening early postmenopausal White women for osteoporosis. However, a better osteoporosis screening tool remains to be developed.

Risk Assessment Tools for Osteoporosis Screening in Postmenopausal Women: A Systematic Review

Osteoporotic fractures are common in postmenopausal women. Tools are available to estimate the risk of low bone mineral density (BMD) or fracture. This systematic review retrieved articles that evaluated osteoporosis risk assessment tools among postmenopausal women in North America. For identifying BMD T-score ≤-2.5, most studies of the Simple Calculated Osteoporosis Risk Estimation tool (SCORE) and Osteoporosis Risk Assessment Instrument (ORAI) reported sensitivity ≥90 %. Area under the receiver operating characteristic curve (AUC) was usually <0.75 for SCORE and ≥0.75 for ORAI. Among women 50-64 years old, a Fracture Risk Assessment Tool (FRAX) threshold ≥9.3 % had a sensitivity of 33 % for identifying BMD T-score ≤-2.5 and 26 % for predicting major osteoporotic fracture (MOF). For predicting MOF, sensitivity was higher for SCORE and Osteoporosis Self-assessment Tool equation (OST), and higher in women ≥65 years old. For predicting BMD T-score ≤-2.5 in women ≥65 years old, the sensitivities of SCORE; ORAI; and Age, Body Size, No Estrogen (ABONE) were very high. No optimal osteoporosis risk assessment tool is available for identifying low BMD and MOF risk.

Strategies to overcome barriers to implementing osteoporosis and fracture prevention guidelines in long-term care: a qualitative analysis of action plans suggested by front line staff in Ontario, Canada.

BackgroundOsteoporosis is a major global health problem, especially among long-term care (LTC) facilities. Despite the availability of effective clinical guidelines to prevent osteoporosis and bone fractures, few LTC homes actually adhere to these practical recommendations. The purpose of this study was to identify barriers to the implementation of evidence-based practices for osteoporosis and fracture prevention in LTC facilities and elicit practical strategies to address these barriers.MethodsWe performed a qualitative analysis of action plans formulated by Professional Advisory Committee (PAC) teams at 12 LTC homes in the intervention arm of the Vitamin D and Osteoporosis Study (ViDOS) in Ontario, Canada. PAC teams were comprised of medical directors, administrators, directors of care, pharmacists, dietitians, and other staff. Thematic content analysis was performed to identify the key themes emerging from the action plans.ResultsLTC teams identified several barriers, including lack of educational information and resources prior to the ViDOS intervention, difficulty obtaining required patient information for fracture risk assessment, and inconsistent prescribing of vitamin D and calcium at the time of admission. The most frequently suggested recommendations was to establish and adhere to standard admission orders regarding vitamin D, calcium, and osteoporosis therapies, improve the use of electronic medical records for osteoporosis and fracture risk assessment, and require bone health as a topic at quarterly reviews and multidisciplinary conferences.ConclusionsThis qualitative study identified several important barriers and practical recommendations for improving the implementation of osteoporosis and fracture prevention guidelines in LTC settings.

Serologically Determined Gastric Mucosal Condition Is a Predictive Factor for Osteoporosis in Japanese Men.

There are few reports about the influence of Helicobacter pylori infection and/or atrophic gastritis on bone conditions in Japan. To assess whether the combination of serologically determined Helicobacter pylori infection and atrophic gastritis is available as a biomarker for bone conditions. We studied 230 men in their 50s and 60s. Helicobacter pylori infection was determined using serum antibody to this bacterium. Atrophic gastritis was diagnosed on the basis of the serum pepsinogen I and II criteria. The characteristics of the participants' bone were measured at the radius using an ultrasonic bone densitometry system. The risks of low trabecular bone density, low elastic modulus of trabecular bone, and low cortical thickness among subjects who were positive for Helicobacter pylori infection and/or atrophic gastritis relative to those who were not were calculated. Helicobacter pylori infection significantly increased the risk of low trabecular bone density (odds ratio 1.83, 95 % confidence interval 1.04-3.21, P = 0.03). Atrophic gastritis significantly increased the risk of low trabecular bone density (2.22, 1.17-4.22, 0.01). Compared with anti-Helicobacter pylori antibody (-) and atrophic gastritis (-) subjects, anti-Helicobacter pylori antibody (+) and atrophic gastritis (+) subjects were a significant high-risk group for low trabecular bone density (2.65, 1.27-5.55, 0.01). A serological diagnosis of Helicobacter pylori infection and atrophic gastritis, which is utilized for risk assessment of gastric cancer, was suggested to be useful for risk assessment of osteoporosis.

Systematic review and meta-analysis of the performance of clinical risk assessment instruments for screening for osteoporosis or low bone density.

We performed a systematic review and meta-analysis of the performance of clinical risk assessment instruments for screening for DXA-determined osteoporosis or low bone density. Commonly evaluated risk instruments showed high sensitivity approaching or exceeding 90% at particular thresholds within various populations but low specificity at thresholds required for high sensitivity. Simpler instruments, such as OST, generally performed as well as or better than more complex instruments. The purpose of the study is to systematically review the performance of clinical risk assessment instruments for screening for dual-energy X-ray absorptiometry (DXA)-determined osteoporosis or low bone density. Systematic review and meta-analysis were performed. Multiple literature sources were searched, and data extracted and analyzed from included references. One hundred eight references met inclusion criteria. Studies assessed many instruments in 34 countries, most commonly the Osteoporosis Self-Assessment Tool (OST), the Simple Calculated Osteoporosis Risk Estimation (SCORE) instrument, the Osteoporosis Self-Assessment Tool for Asians (OSTA), the Osteoporosis Risk Assessment Instrument (ORAI), and body weight criteria. Meta-analyses of studies evaluating OST using a cutoff threshold of <1 to identify US postmenopausal women with osteoporosis at the femoral neck provided summary sensitivity and specificity estimates of 89% (95%CI 82-96%) and 41% (95%CI 23-59%), respectively. Meta-analyses of studies evaluating OST using a cutoff threshold of 3 to identify US men with osteoporosis at the femoral neck, total hip, or lumbar spine provided summary sensitivity and specificity estimates of 88% (95%CI 79-97%) and 55% (95%CI 42-68%), respectively. Frequently evaluated instruments each had thresholds and populations for which sensitivity for osteoporosis or low bone mass detection approached or exceeded 90% but always with a trade-off of relatively low specificity. Commonly evaluated clinical risk assessment instruments each showed high sensitivity approaching or exceeding 90% for identifying individuals with DXA-determined osteoporosis or low BMD at certain thresholds in different populations but low specificity at thresholds required for high sensitivity. Simpler instruments, such as OST, generally performed as well as or better than more complex instruments.

Age impact on clinical risk factors does not justify the age related change in referral pattern for osteoporosis assessment—Data from the Aalborg University Hospital Record for Osteoporosis Risk Assessment (AURORA)

BackgroundOsteoporotic fractures with subsequent disability, dependency and premature death are increasingly common with age. Yet, referral for osteoporosis evaluation decreases with age. Why is this, and is it justified? PurposeTo assess if age changes the impact of clinical risk factors for osteoporosis. MethodsClinical risk factors for osteoporosis were informed by a questionnaire and recorded in the AURORA database along with anthropometry and bone mineral density measured by dual energy X-ray absorptiometry (DXA). We included data from the first DXA in all individuals seen at the Osteoporosis Clinic in North Denmark in 2010 through 2012. ResultsRisk factor data were available in >96% and DXA in >98% of the 8131 evaluations. Age 80+ years was the dominant risk factor for fragility fracture (P<0.001) and for osteoporosis by DXA (P<0.001). The occurrence of clinical risk factors differed by age <80 or 80+ years: P<0.001 for family history, present smoker, excess alcohol intake, secondary disease, low sun exposure, fragility fracture; P=0.002 for early menopause; P=0.015 for corticosteroid; P=0.046 for low dairy product consumption. Age increased the impact of female gender (interaction term in logistic regression: P=0.004 for fragility fracture; P=0.040 for BMD). Age had no influence on the importance of any other clinical risk factor for the occurrence of fragility fracture. ConclusionHigh age carried the highest risk for fragility fracture and for osteoporosis by DXA. Clinical risk factors changed with age in those referred for evaluation. This change was not justified by the impact of clinical risk factors.

Metabolic Syndrome and Menopause: Pathophysiology, Clinical and Diagnostic Significance.

Menopause is a risk factor for cardiometabolic diseases, including metabolic syndrome (MetS), type 2 diabetes, and cardiovascular diseases. MetS is a constellation of interdependent factors such as insulin resistance, abdominal obesity, dyslipidemia, and hypertension. The prevalence of MetS in postmenopause is due to loss of the protective role of estrogens and increased circulating androgens resulting in changes to body fat distribution and development of abdominal obesity. Excessive visceral adipose tissue plays an important role due to synthesis and secretion of bioactive substances such as adipocytokines, proinflammatory cytokines, reactive oxygen species, prothrombotic, and vasoconstrictor factors. MetS may also impact risk assessment of breast cancer, osteoporosis and chronic kidney disease, and quality of life during the menopausal transition. Increased MetS has stimulated the exploration of new laboratory tests for early detection and therapies.

Osteoporosis Prevention: Narrowing the Gap Between Knowledge and Application

Osteoporosis is the most prevalent bone health issue for the elderly in the United States, creating huge economic, social, and emotional burdens in our older population. Despite proven strategies to prevent osteoporosis, primary care providers do not provide adequate osteoporosis prevention education. To address this problem, an evidence-based osteoporosis prevention intervention project was implemented to increase osteoporosis prevention education by providers at an urban community clinic. A preintervention and 6-month postintervention chart review showed significant improvement in osteoporosis risk assessment with recommendations for calcium/vitamin D as well as small gains in education on lifestyle modification.

Osteoporosis risk assessment in a welsh district general hospital

Osteoporosis risk assessment in a welsh district general hospital

Age discrimination in osteoporosis screening—Data from the Aalborg University Hospital Record for Osteoporosis Risk Assessment (AURORA)

BackgroundOld age carries a markedly increased risk of osteoporotic fractures with subsequent disability, dependency and premature death. Timely detection and treatment reduces fracture risk and particular attention should be drawn to age. ObjectiveTo assess the impact of age on referral for osteoporosis screening. Setting and MethodsDual energy X-ray Absorptiometry (DXA) at the Osteoporosis Clinic in North Denmark was reorganised from 2010. Risk factors, anthropometry and bone mineral density were recorded and considered in the reply and recommendations to the referring doctor. We report data from the 8,131 consecutive evaluations in 7914 individuals at the Osteoporosis Clinic from January 1st 2010 through December 31st 2012. ResultsRisk factor data were available in >96% and DXA in 98%. Population DXA frequency decreased markedly after the 7th decade and was performed yearly in 1.2% of the population aged >80 years in North Denmark. The >80 years group had more fragility fractures and lower T-scores (p<0.001) compared to those below 80 years of age, and age >80 years was a dominant risk factor for fragility fracture (OR 2.4, 95% CI 2.0–2.9; p<0.001) and for having diagnosed osteoporosis by DXA (OR 2.1, 95% CI 1.7, 2.5; p<0.001). ConclusionReferral for osteoporosis screening decreased after the 7th decade despite the finding that high age carried the highest risk of osteoporosis by DXA and by fragility fracture. Osteoporosis is a disease of aging, but it is apparently not recognised as such. This is likely to cause undertreatment among the old.

Role of family medicine in the early detection and management of osteoporosis

Objectives The aim was to study the epidemiology, pathophysiology, and risk assessment of osteoporosis among adults as a major health problem and clarify the role of the family physician in the prevention, screening, early detection, and management of osteoporosis. Data analysis Osteoporosis is a multifactorial skeletal disease characterized by reduction in bone mass and deterioration of the microarchitectural structure of bone tissue, with resulting increase in bone fragility and fracture risk. A decline in bone mineral density with age increases bone fragility because it reflects the progressive loss of bone mass and changes in the architecture of the bone, such as cortical thinning, cortical porosity, and thinning and loss of trabeculae with loss of connectedness of trabeculae. Bone loss is progressive and is not associated with symptoms until a fracture occurs - the main clinical feature of osteoporosis. Recent finding Worldwide, osteoporosis causes more than 8.9 million fractures annually, resulting in an osteoporotic fracture every 3 s. Osteoporosis is estimated to affect 200 million women worldwide. Egyptian studies show that 53.9% of postmenopausal women have osteopenia, whereas 28.4% have osteoporosis, and 21.9% of men aged 20-89 years have osteoporosis. Conclusion As the clinical outcome of osteoporosis is bone fracture, attention is now increasingly focused on the identification of patients at high risk for fracture rather than the identification of people with osteoporosis as defined by bone mineral density alone.