Osteoporosis: should there be a screening programme in Hong Kong?
OBJECTIVE
Osteoporosis is rapidly becoming a major health problem in Hong Kong with the ever-increasing population of elderly people. Its importance lies in the predisposition to fragility fractures of patients with the disease. These fractures incur morbidity and mortality to the elderly. Measures are needed to reduce the prevalence of osteoporosis and the incidence of osteoporotic fractures. A screening programme is potentially the way forward in achieving such a goal.


METHODS
The need for, and the feasibility of, a screening programme for osteoporosis in Hong Kong were evaluated. A comprehensive examination of the relevant issues was carried out within the framework of the World Health Organization criteria on screening of diseases. Major studies from abroad and Hong Kong were discussed and the strength of evidence was assessed.


RESULTS
Osteoporosis satisfies some of the World Health Organization criteria for screening of diseases: it is a significant health problem, the natural history is fairly well understood, and early detection is possible. Nevertheless, there remain unresolved issues related to the screening tests, the treatments currently available, and the selection criteria for treatment. Several therapeutic options have been tested in trials. However, more work is needed to determine whether, in addition to increasing bone mass, they reduce the incidence of fracture. Moreover, the duration of therapy needed to achieve long-term benefit has yet to be established. More studies are also needed to evaluate the cost-effectiveness of such a programme.


CONCLUSIONS
There undoubtedly needs to be a means of identifying individuals who have osteoporosis and are susceptible to fragility fractures. However, based on the currently available evidence, large-scale screening is not a valid option. Before instituting such a programme in Hong Kong, more studies are needed to determine the most appropriate and cost-effective way forward.
Hui
Y
Y
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
D003362:Cost-Benefit Analysis; D005260:Female; D006723:Hong Kong; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000592:standards*; D010024:Osteoporosis / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy; D017410:Practice Guidelines as Topic; D014944:World Health Organization