title: What's in a name? What constitutes the clinical diagnosis of osteoporosis?
abstract: Osteoporosis is a skeletal disorder in which reductions in bone strength predispose to an increased risk for fractures. Currently, the diagnosis is officially made based exclusively on bone mineral density T-scores that are ≤-2.5 at the spine or hip. Limiting the clinical diagnosis of osteoporosis solely to a T-score-based criterion, which is the official convention in the USA, creates uncertainty about the use of the term osteoporosis to diagnose older women and men who have T-scores >-2.5, but either have already sustained low-trauma fractures or are recognized as having high fracture risk based on absolute fracture risk calculations from FRAX or other algorithms. A failure to diagnose such patients as having osteoporosis may be one component of the well-documented underdiagnosis and undertreatment of this disease which limits our ability to reduce the burden of fractures worldwide. There is a need to expand the criteria for making a clinical diagnosis and to codify these changes in order to help patients, physicians, policy makers, and payers better understand who has this disease and the elevated risk for fracture that it represents.
authors.affiliation: Toni Stabile Osteoporosis Center and Metabolic Bone Diseases Program, Division of Endocrinology, Department of Medicine, Columbia University Medical Center, 180 Fort Washington Avenue, New York, NY 10032, USA. es27@columbia.edu
authors.forename: E S
authors.initials: ES
authors.lastname: Siris
authors.forename: S
authors.initials: S
authors.lastname: Boonen
authors.forename: P J
authors.initials: PJ
authors.lastname: Mitchell
authors.forename: J
authors.initials: J
authors.lastname: Bilezikian
authors.forename: S
authors.initials: S
authors.lastname: Silverman
mesh_terms: D015502:Absorptiometry, Photon; D000465:Algorithms; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D006615:Hip / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008954:Models, Biological; D010024:Osteoporosis / Q000175:diagnosis* / Q000188:drug therapy; D058866:Osteoporotic Fractures / Q000175:diagnosis* / Q000517:prevention & control; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013131:Spine / Q000000981:diagnostic imaging; D014481:United States; D014944:World Health Organization
chemical_list: D050071:Bone Density Conservation Agents