title: Recommendations for bone mineral density reporting in Canada: a shift to absolute fracture risk assessment.
abstract: In June 2005, new Canadian recommendations for bone mineral density (BMD) reporting in postmenopausal women and older men were published by Osteoporosis Canada (formerly the Osteoporosis Society of Canada) and the Canadian Association of Radiologists. The recommendations were developed by a multidisciplinary working group that included the Canadian Panel of the International Society for Clinical Densitometry and were reviewed and endorsed by multiple stakeholders. Previous Canadian osteoporosis guidelines advised intervention based on an individual's World Health Organization category (normal, osteopenia, or osteoporosis) as a marker of relative fracture risk. In the new approach, an individual's 10-yr absolute fracture risk, rather than BMD alone, is used for fracture risk categorization. Absolute fracture risk is determined using not only BMD results, but also age, sex, fragility fracture history, and glucocorticoid use. A procedure is presented for estimating absolute 10-yr fracture risk in untreated individuals, leading to assigning an individual to 1 of 3 absolute fracture risk categories: low risk (<10% 10-yr fracture risk), moderate risk (10-20%), and high risk (>20%). We propose that an individual's absolute fracture risk category should be the basis for deciding on treatment and frequency of BMD monitoring.
authors.affiliation: Department of Radiology and Diagnostic Imaging and Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, Canada. kerrygs@telusplanet.net
authors.forename: Kerry
authors.initials: K
authors.lastname: Siminoski
authors.forename: William D
authors.initials: WD
authors.lastname: Leslie
authors.forename: Heather
authors.initials: H
authors.lastname: Frame
authors.forename: Anthony
authors.initials: A
authors.lastname: Hodsman
authors.forename: Robert G
authors.initials: RG
authors.lastname: Josse
authors.forename: Aliya
authors.initials: A
authors.lastname: Khan
authors.forename: Brian C
authors.initials: BC
authors.lastname: Lentle
authors.forename: Jacques
authors.initials: J
authors.lastname: Levesque
authors.forename: David J
authors.initials: DJ
authors.lastname: Lyons
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarulli
authors.forename: Jacques P
authors.initials: JP
authors.lastname: Brown
mesh_terms: D015502:Absorptiometry, Photon; D015519:Bone Density / Q000502:physiology*; D002170:Canada / Q000453:epidemiology; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D017410:Practice Guidelines as Topic; D012042:Registries; D012307:Risk Factors