An Approach to Identifying Osteopenic Women at Increased Short-term Risk of Fracture

Abstract

This classification tool accurately identified postmenopausal women with peripheral T scores of -2.5 to -1.0 who are at increased risk of fracture within 12 months. It can be used in clinical practice to guide assessment and treatment decisions.

Ten-year fracture probability identifies women who will benefit from clodronate therapy—additional results from a double-blind, placebo-controlled randomised study

“…In the past decade, other factors have been identified that contribute to fracture risk, partially or wholly independent of BMD, which improve fracture prediction and the selection of individuals at high risk for treatment [10,12,[25][26][27]. A series of meta-analyses using individualised data from 12 global population cohorts [28][29][30][31][32][33][34][35] has identified clinical risk factors for use in the assessment of fracture risk with or without the use of BMD.…”

“…It is clear, however, that at least half of hip fractures and a larger proportion of clinical fractures occur in individuals with osteopenia rather than osteoporosis [8,9]. The poor sensitivity of the BMD osteoporosis threshold for fracture has led to the development of several fracture prediction tools that attempt to integrate other clinical risk factors with BMD to enhance fracture prediction [10][11][12]. The World Health Organization has recently developed a highly sophisticated algorithm for the estimation of 10-year fracture probability of individuals that has been validated in several population cohorts [13].…”

Validation of the Cummings’ risk score; how well does it identify women with high risk of hip fracture: The Tromsø Study

“…Moreover, the use of forearm BMD compared to calcaneal BMD in the original study may underestimate the results in this study as calcaneal BMD is a better predictor of hip fractures [2]. However forearm BMD measurement has been described to predict hip fractures well, although not as well as hip BMD [21,31,32]. At the time of the fourth survey (1994/95) forearm BMD screening was the only practical alternative compared to the long time Table 1) are: weight loss (>5 kg) or BMI < 20 kg/m 2 , height ‡ 168 cm, maternal history of hip fracture, any fracture (except of the hip) since age of 50, self-reported health (good or poor health), physically inactive (no activity), using long-acting benzodiazepines, using anticonvulsant drugs, pulse rate >80 beats/min, caffeine intake more than the equivalent of two cups of coffee/day, unable to rise from chair without help, self-reported hyperthyroidism, and age ‡ 80 at the time of BMD measurement.…”

“…On the other hand, non-BMD risk factors independently play a major role in the prediction of osteoporosis [6][7][8][9] and hip fracture [10][11][12][13]. Combining BMD measurements with non-BMD risk factors allows better assessment of fracture risk [14][15][16][17][18][19] and help targeting prevention to high risk individuals as shown in earlier studies [12,[20][21][22][23][24][25]. These studies have developed differently defined risk scores, but validations of these risk-scores in other populations are scarce.…”

Validation of a 5-year risk score of hip fracture in postmenopausal women. The Danish Nurse Cohort Study

“…The prognostic performance can be improved by combining these risk factors, e. g. women with eight or more risk factors may have a higher risk of fracture compared to women with four or fewer risk factors [7]. The knowledge about risk factors has been used to develop a number of screening tools to identify women at risk of osteoporosis and most of these use bone mineral density (BMD) as the outcome [9][10][11][12][13][14]. While BMD is a strong risk factor for fracture, Black et al [9] developed two algorithms to assess the 5-year risk of hip fractures, one without BMD testing and one with.…”