Tufts researcher leads revision of osteoporosis guidelines

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Public release date: 5-Jun-2008

http://www.eurekalert.org/pub_releases/2008-06/tuhs-trl060508.php

Contact: Grossman

Tufts University, Health Sciences

Tufts researcher leads revision of osteoporosis guidelines

Tufts University researcher Bess Dawson-, M.D., chaired the

committee that recently updated the National Osteoporosis Foundation

(NOF) Clinician's Guide to Prevention and Treatment of Osteoporosis. The

new Clinician's Guide incorporates the World Health Organization (WHO)

absolute fracture prediction algorithm (FRAX®), a computer-based tool

expected to increase the identification of patients at risk for

osteoporosis.

" The introduction of the WHO's fracture prediction algorithm

necessitated the revision of the Clinician's Guide, " says Dawson-,

director of the Bone Metabolism Laboratory at the Mayer USDA Human

Nutrition Research Center on Aging at Tufts University. " The algorithm

tells clinicians how likely a patient is to fracture a bone due to

osteoporosis or low bone mass in the 10 years following examination,

also known as 10-year fracture risk. This can help clinicians decide

whether a patient needs to be treated or simply monitored. "

Writing in the April 2008 issue of the journal Osteoporosis

International, corresponding author Dawson- and colleagues

describe how to apply FRAX® in the United States. Clinicians estimate a

patient's 10-year fracture risk using a computer program that considers

bone mineral density (BMD) score, or T-score, and nine clinical risk

factors including personal fracture history, family fracture history,

weight, race and gender. Notably, FRAX® and the new Clinician's Guide

now apply to men over 50 and post-menopausal non-Caucasian women,

including African-Americans, Asians and Latinas. Previous versions

applied only to post-menopausal Caucasian women, the group at

highest-risk for osteoporosis.

In their analysis, Dawson- and colleagues highlight the inclusion

of men in the guide. " Post menopausal women remain the most vulnerable

to osteoporotic fractures, yet clinicians should not overlook men

because their fracture risk may be lower, " says Dawson-, who is

also a professor at Tufts University School of Medicine. " The new

U.S.-adapted FRAX® will help identify high-risk subgroups of men and

non-Caucasian women and, we hope, a wider population of patients at risk

for osteoporosis will be treated. Use of FRAX® in men and non-Caucasian

women will require adjustments in their T-scores that currently appear

on bone density reports. "

Additionally, FRAX® and the new Clinician's Guide address the

cost-effectiveness of prescribing medication to patients with low bone

mass, but not osteoporosis. Dawson- and colleagues performed an

economic analysis that calls for treating patients with a 10-year hip

fracture risk of 3 percent or greater or a major fracture risk of 20

percent or greater. That would include; patients with fragility

fractures or osteoporosis, older patients at risk for osteoporosis and

younger patients presenting additional clinical risk factors for

fracture. FRAX® is applicable to men and women over age 50, but not to

younger people.

" The ability to estimate 10-year fracture risk is a crucial development

in osteoporosis care, but it is still important for clinicians to review

patient cases on an individual basis, " says Dawson-. " Ten-year

fracture risk should be used as a guideline. "

The following are some recommendations from the new Clinician's Guide:

* BMD testing for women age 65 and older and men age 70 and older

and in post-menopausal women age 50-70 who present with certain risk

factors.

* Treatment in postmenopausal women and in men age 50 and older

with low bone mass at the femoral neck, total hip or spine and 10-year

hip fracture probability of 3 percent or more, or, a 10-year major

fracture risk of 20 percent or more based on the US-adapted WHO absolute

fracture risk model.

* Regular weight-bearing and muscle-strengthening exercise to

reduce the risk of falls and fractures.

* Advise on adequate amounts of calcium (at least 1200 mg per day,

including supplements (if necessary) and vitamin D (800 to 1000 IU per

day of vitamin D for individuals at risk of insufficiency).

" We continue to stress the importance of taking calcium and vitamin D

for optimal bone health, " says Dawson-, who has published several

papers on the subject. " Previous studies suggest these nutrients help

strengthen bones which is beneficial for all adults, even those who show

no signs of osteoporosis. "

###

Dawson-, B, Tosteson, ANA, Melton, LJ III, Baim, S, Favus MJ,

Khosla, S, RL. Osteoporosis International. 2008 (April); 19:

449-458.

*Select information in this news release was provided by the National

Osteoporosis Foundation, which also funded a portion of the study.

If you are a member of the media interested in learning more about this

topic, or speaking with another Tufts health sciences researcher, please

contact Grossman at or Fennelly at

.

--

ne Holden, MS, RD

" Ask the Parkinson Dietitian " http://www.parkinson.org/

" Eat well, stay well with Parkinson's disease "

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