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Choosing the Right Patients for Osteoporosis Treatment

Since 1994, osteoporosis has been diagnosed based on bone density measurements. Treatment is started when the score for bone density drops below -2.5. This score means the person's peak bone density is two and a half standard deviations below the average peak bone density in young adults.

But new guidelines have been made recently. Studies show that using bone mineral density (BMD) alone may not be enough. Fractures can and do occur in women who have normal BMD. And there may even be more fractures in groups of people with low bone mass. These are men and women who are not yet osteoporotic.

Low bone mass of this type is called osteopenia. The increased number of fractures in adults with osteopenia may occur simply because there are more older adults now than ever before. And more older adults have osteopenia than ever before.

The World Health Organization (WHO) suggests using the BMD along with clinical risk factors to predict the risk of fractures and to guide treatment. The two most important risk factors for bone fracture are age and previous history of bone fracture. Other important risk factors include the use of medications such as corticosteroids, cigarette smoking, and daily alcohol use (more than two drinks per day).

Combining clinical risk factors with BMD may help identify people who are at moderate risk. For regions where BMD testing isn't available, then the risk factors can be used to guide treatment. In fact, the clinical risk factors can be used to predict the chances of having a hip or other fracture over the next 10 years.

References: Stuart L. Silverman, MD. Selecting Patients for Osteoporosis Therapy: A New Approach. In The Journal of Musculoskeletal Medicine. May 2007. Vol. 24. No. 5. Pp. 207-211.

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