Using the same bone density reference database for men and women provides a simpler estimation of fracture risk

Langsetmo, Lisa; Leslie, William D.; Zhou, Wei; Goltzman, David; Kovacs, Christopher S.; Prior, Jerilynn C.; Josse, Robert G.; Olszynski, Wojciech P.; Davison, K. Shawn; Anastassiades, Tassos; Towheed, Tanveer; Hanley, David A.; Kaiser, Stéphanie; Kreiger, Nancy

doi:10.1002/jbmr.112

Cited by 28 publications

(18 citation statements)

References 25 publications

(28 reference statements)

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“…Indeed, overlap, with similarity, but not identity, has been reported. 27, 29, 30 In summary, it appears that at the same DXA-measured BMD, men and women are at approximately the same fracture risk. As such, use of the same database to derive the T-score is reasonable.…”

Section: T-score Derivation In Menmentioning

confidence: 88%

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Osteoporosis Diagnosis in Men: The T-Score Controversy Revisited

Binkley¹,

Adler

Bilezikian

2014

Curr Osteoporos Rep

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Osteoporosis becomes common with aging in both sexes, but is often ignored in men. The 2013 International Society for Clinical Densitometry consensus conference endorsed a Caucasian female referent database for T-score calculation in men. This recommendation has generated controversy and concern. Accumulating data indicate that at the same DXA-measured BMD (g/cm2), men and women are at approximately the same fracture risk. With this point in mind, using the same database to derive the T-score in men and women is reasonable. As a result, a greater proportion of men who sustain a fragility fracture will have T-scores that are higher than they would if a male database were used; in fact, many men will fracture at T-scores that are “normal.” This highlights the importance of diagnosing osteoporosis not just by T-score, but also by the presence of fragility fracture and/or by estimations of fracture risk as generated by tools such as the FRAX calculator. The practical consequences of this change in densitometric definition of osteoporosis in men should be monitored, including the proportion of men at risk identified and treated as well as defining the response to treatment in those assessed by this more comprehensive approach.

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Section: T-score Derivation In Menmentioning

confidence: 88%

“…26 Consistent with this, men and women were found to have similar absolute risk for vertebral and all fractures at the same BMD. 27, 28 However, not all studies find that men and women fracture at the same absolute BMD. Indeed, overlap, with similarity, but not identity, has been reported.…”

Section: T-score Derivation In Menmentioning

confidence: 99%

Osteoporosis Diagnosis in Men: The T-Score Controversy Revisited

Binkley¹,

Adler

Bilezikian

2014

Curr Osteoporos Rep

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“…The development of new techniques for measuring BMD has focused much of the recent research in the clinical setting, but the mechanical aspects have not been adequately studied [88][89][90][91] . Nonetheless, all models assume that BMD is the basic measurement, and it should therefore be used as a benchmark in predicting fracture risk.…”

Section: Risk Of Fracturementioning

confidence: 99%

Male osteoporosis: A review

Herrera

Lobo-Escolar²,

Mateo³

et al. 2012

WJO

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Osteoporosis in men is a heterogeneous disease that has received little attention. However, one third of worldwide hip fractures occur in the male population. This problem is more prevalent in people over 70 years of age. The etiology can be idiopathic or secondary to hypogonadism, vitamin D deficiency and inadequate calcium intake, hormonal treatments for prostate cancer, use of toxic and every disease or drug use that alters bone metabolism. Risk factors such as a previous history of fragility fracture should be assessed for the diagnosis. However, risk factors in men are very heterogeneous. There are significant differences in the pharmacological treatment of osteoporosis between men and women fundamentally due to the level of evidence in published trials supporting each treatment. New treatments will offer new therapeutic prospects. The goal of this work is a revision of the present status knowledge about male osteoporosis.

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“…Several previous surveys have assessed the risk of fracture using various methodologies, but mostly based on BMD measurements [15,16]. BMD measurements have also been used for determining the mechanical strength [17] or to develop statistical models for predicting the risk of fracture [18].…”

Section: Introductionmentioning

confidence: 99%

A mechanical model for predicting the probability of osteoporotic hip fractures based in DXA measurements and finite element simulation

et al. 2012

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BackgroundOsteoporotic hip fractures represent major cause of disability, loss of quality of life and even mortality among the elderly population. Decisions on drug therapy are based on the assessment of risk factors for fracture, from BMD measurements. The combination of biomechanical models with clinical studies could better estimate bone strength and supporting the specialists in their decision.MethodsA model to assess the probability of fracture, based on the Damage and Fracture Mechanics has been developed, evaluating the mechanical magnitudes involved in the fracture process from clinical BMD measurements. The model is intended for simulating the degenerative process in the skeleton, with the consequent lost of bone mass and hence the decrease of its mechanical resistance which enables the fracture due to different traumatisms. Clinical studies were chosen, both in non-treatment conditions and receiving drug therapy, and fitted to specific patients according their actual BMD measures. The predictive model is applied in a FE simulation of the proximal femur. The fracture zone would be determined according loading scenario (sideway fall, impact, accidental loads, etc.), using the mechanical properties of bone obtained from the evolutionary model corresponding to the considered time.ResultsBMD evolution in untreated patients and in those under different treatments was analyzed. Evolutionary curves of fracture probability were obtained from the evolution of mechanical damage. The evolutionary curve of the untreated group of patients presented a marked increase of the fracture probability, while the curves of patients under drug treatment showed variable decreased risks, depending on the therapy type.ConclusionThe FE model allowed to obtain detailed maps of damage and fracture probability, identifying high-risk local zones at femoral neck and intertrochanteric and subtrochanteric areas, which are the typical locations of osteoporotic hip fractures.The developed model is suitable for being used in individualized cases. The model might better identify at-risk individuals in early stages of osteoporosis and might be helpful for treatment decisions.

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Using the same bone density reference database for men and women provides a simpler estimation of fracture risk

Cited by 28 publications

References 25 publications

Osteoporosis Diagnosis in Men: The T-Score Controversy Revisited

Osteoporosis Diagnosis in Men: The T-Score Controversy Revisited

Male osteoporosis: A review

A mechanical model for predicting the probability of osteoporotic hip fractures based in DXA measurements and finite element simulation

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