Assessing the risk of vertebral osteoporosis.
Assessment of osteoporosis includes an accurate diagnosis, a consideration of the differential diagnosis, and prognostic assessment. Diagnosis of osteoporosis is based on bone mineral density (BMD) measurements and is defined as a BMD value that is 2.5 standard deviations or more below the average value in young healthy women (T score < or = -2.5 SD). Established osteoporosis is defined as a T-score of < or = -2.5 SD in the presence of a prior fragility fracture. The assessment of prognosis is important for defining intervention thresholds. Future fracture risk depends not only on BMD, but also on age. In addition, a variety of risk factors have been identified that increase fracture risk over and above that provided by BMD and age. Of particular importance is a prior fragility fracture, low body mass index and use of corticosteroids. The combination of independent risk factors permits a more accurate stratification of risk so that more patients at high risk can be identified. Risk of future fracture is optimally expressed as a probability. Ten-year fracture probabilities are appropriate for clinical use. The impact of BMD, age and other risks on fracture probability have recently been determined and provide a mechanism for optimising assessment of patients so that treatments can be efficiently directed to those most in need.
Kanis
J A
JA
Centre for Metabolic Bone Diseases (WHO Collaborating Centre), University of Sheffield Medical School, UK.
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis* / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D013122:Spinal Diseases / Q000175:diagnosis* / Q000453:epidemiology; D016103:Spinal Fractures / Q000453:epidemiology / Q000209:etiology; D013548:Sweden / Q000453:epidemiology