[Osteoporosis in elderly women should always be treated, despite the new professional guideline from the Dutch Institute for Health Care Improvement (CBO)].
According to the Dutch Institute for Healthcare Improvement [Dutch acronym: CBO] professional guideline 'Osteoporosis' (second revision), the treatment of osteoporosis should be based on the patient's age because bone loss at an advanced age is thought to be partly physiological. It is recommended that women < 70 years old are treated if the bone mineral density T-score is below -2.5. For women > or = 70 years of age, a lower cut-off point has been chosen, i.e. a Z-score below -1. However, bone strength is dependent on bone mineral density and the fracture risk doubles if the bone mineral density decreases by one standard deviation. Therefore at an advanced age, any bone loss experienced increases the fracture risk, whether or not the mineral loss is physiological. Moreover, most elderly people carry additional risk factors that increase fracture risk. Therefore in women > or = 70 years of age, the treatment of osteoporosis should be considered if the T-score is below -2.5. In this situation, use of the Z-score is not appropriate.
Izaks
G J
GJ
Academisch Ziekenhuis, afd. Algemene Interne Geneeskunde/Geriatrie, Postbus 30.001, 9700 RB Groningen. g.izaks@int.azg.nl
Westendorp
R G J
RG
D000367:Age Factors; D000368:Aged; D000375:Aging / Q000502:physiology*; D015519:Bone Density; D002136:Calcium, Dietary / Q000008:administration & dosage; D005260:Female; D050723:Fractures, Bone / Q000209:etiology; D006801:Humans; D008297:Male; D008593:Menopause / Q000502:physiology; D009426:Netherlands; D010024:Osteoporosis / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D012955:Societies, Medical
D002136:Calcium, Dietary
Osteoporose bij oudere vrouwen altijd behandelen, ondanks de nieuwe CBO-richtlijn.