Recommendations Urge Bone Density Tests for Certain Postmenopausal Women; Women 65+
Responding to a critical need for early intervention and clear practice guidelines for physicians, the National Osteoporosis Foundation (NOF) today issued specific and aggressive recommendations for managing and preventing osteoporosis, including specific guidelines on the use of bone mineral density (BMD) tests, the single most reliable tool for assessing bone strength and osteoporosis risk. The Physician's Guide to Prevention and Treatment of Osteoporosis was developed by NOF in collaboration with ten multidisciplinary medical organizations. The guide gives specific recommendations for Caucasian women, the population at highest risk for the disease, and about whom most of the data exists.
Key Recommendations
The recommendations specify that the following people should have a BMD test: women who are 65 and older, regardless of other risk factors(1); postmenopausal women who have one or more risk factors for osteoporotic fracture (besides menopause); and all postmenopausal women who have a fracture. All postmenopausal women who present with vertebral or hip fractures, two of the most common osteoporosis fracture sites, should be considered candidates for osteoporosis treatment.
"Osteoporosis is a 'silent' risk factor for fracture, just as hypertension is for stroke. Prevention, detection and treatment of osteoporosis should be a mandate of primary care, and a routine part of physicals," says NOF president Robert Lindsay, M.D., Ph.D. "Bone density tests are now widely available and should be offered to these high risk women to detect low bone density before their bones weaken and fractures occur."
Treatment Recommendations
Once patients have a BMD test, a quick, painless test, physicians should use the results to initiate therapy to reduce fracture risk and prevent further bone loss, if bone mass is low. BMD tests provide physicians with a T score expressed in standard deviations; the more negative the number, the greater the risk of fracture. Each standard deviation represents a 10-12% bone loss and a T score of -2.5 indicates osteoporosis. Women with no risk factors should begin therapy if their T score is -2 or below; and women with risk factors should begin therapy if their T score is -1.5 or below.
"Early diagnosis is important because bone loss is progressive, and by the time fractures occur the disease is advanced and the likelihood of further hip, spine or other fractures is great," explains C. Conrad Johnston Jr., M.D., chair of the Physician's Guide Development Committee and vice president of the National Osteoporosis Foundation. "Hip fractures are not only disabling, but can be life-threatening. Twenty percent of people die in the year following a hip fracture."
Universal Recommendations
All adults should: obtain adequate amount of calcium (1200 mg/day) and vitamin D (400 to 800 IU/day), engage in regular weight-bearing exercise, and avoid tobacco smoking or alcohol abuse. These universal recommendations are important to help prevent osteoporosis, and also are important for people on osteoporosis prevention or treatment therapy.
Physician's Guide Addresses Critical Need for Information
The National Osteoporosis Foundation recognizes that osteoporosis is under- diagnosed among postmenopausal women, and that many women are developing osteoporosis without the disease being recognized or treated. Based on a household survey including 1.1 million women receiving medication for osteoporosis, it is estimated that only 14 percent of American women with osteoporosis receive treatment.(2) The survey also estimated that only 29 percent of women with osteoporosis are diagnosed, yet osteoporosis is the underlying cause of at least 90 percent of all hip and spine fractures in older Caucasian women.(3) In another study of 100 patients well over age 60 and currently in the hospital rehabilitation unit, none had been diagnosed with osteoporosis. However, when screened for osteoporosis, 78 percent of all females and 27 percent of all males were at significant risk for fracture.(4)
"With the rapid advances in diagnostic technology and osteoporosis therapies, we feel there is a gap between the science and current clinical practice. This guide will help physicians assess whether symptomless women are developing this disease," explains Lindsay. Only recently has enough data accumulated for the National Osteoporosis Foundation to provide physicians with clear recommendations for using the new technologies and therapies.
"When cholesterol tests first came out, it wasn't clear what the "normal" range was considered to be on the test, or at what number you should begin treatment to prevent heart disease -- the same has been true for bone density tests," explains Lindsay. "But now we have the data, and have written a guide that specifically addresses the interpretation of bone density tests, how to apply the results in clinical practice, and when to use these tests, which can detect the disease in its earliest stages, before osteoporosis develops. If detected early, therapies can be started to prevent the disease."
"It is also important to realize that until very recently there was not much that physicians could do. They lacked treatment options for this disease and bone density tests were not widely available," says Yank Coble Jr., M.D., a trustee of the National Osteoporosis Foundation and American Medical Association representative on NOF's Interspecialty Medical Council.
The Physician's Guide to Prevention and Treatment of Osteoporosis is designed to serve as a basic reference tool for physicians. It is chiefly based on evidence from randomized, controlled clinical trials. Due to the dearth of research data on men and non-Caucasian women, the guide does not provide specific recommendations for populations other than Caucasian women. However, risk factors identified for Caucasian women can be applied to other populations on an individual basis, to aid in making therapeutic decisions. "The release of the physician's guide is an important step forward, however greatly increased funding for medical research through the National Institutes of Health is needed, especially for research on men and non-Caucasian women, so that we can make specific recommendations for everyone," says Sandra C. Raymond, executive director of the National Osteoporosis Foundation.
RESOURCE: National Osteoporosis Foundation Additional resources:
Reversing Osteopenia, McIlwain, Bruce, Cruse, McIlwain, Henry Holt & Co. 2004.
*The purpose of this page and linked pages is to answer common questions for health problems as well as to present unique ideas towards taking care of your health. The ideas, procedures and suggestions are not intended as a substitute from the medical advice of a trained health professional. All matters regarding our health require medical supervision. Consult your physician before adopting the suggestions in this book, as well as about any condition that may require diagnosis or medical attention. The authors disclaim an liability arising directly or indirectly from the use of techniques described here.
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