Osteoporosis diagnostic guidelines expanded

The National Osteoporosis Foundation (NOF) has broadened its guidelines for diagnosing osteoporosis. The new recommendations include non-Caucasian, postmenopausal women and—for the first time—men aged 50 and older.

The guidelines use fracture-risk calculations derived from a new computerized model developed by the World Health Organization. The model, called FRAX, assesses the likelihood a patient will experience an osteoporotic fracture within 10 years.

Because FRAX considers nine risk factors in addition to bone mineral density (BMD) T score, “it will help to resolve much of the uncertainty about management for people with low scores,” said Ethel Siris, MD, president of NOF and director of the osteoporosis center at Columbia University in New York City. The risk factors are age, gender, fracture history, parental hip fracture history, oral steroid therapy, low BMI, femoral neck BMD, secondary osteoporosis, current smoking, and alcohol intake.

The guidelines recommend starting treatment for any patient over age 50 who presents with:

  • Low bone mass (T score from -1.0 to -2.5 at the femoral neck, total hip, or spine) and 10-year probability of hip fracture >3% or a 10-year probability of any major osteoporosis-related fracture ≥20%
  • T score <–2.5 at the femoral neck, total hip or spine after appropriate evaluation to exclude secondary causes
  • Low bone mass (T-score from -1.0 to -2.5 at the femoral neck, total hip, or spine) and secondary causes associated with high fracture risk (such as glucocorticoid use or immobilization)
  • A hip or vertebral (clinical or morphometric) fracture
  • Other prior fractures and low bone mass (BMD T score from -1.0 to -2.5 at the femoral neck, total hip, or the spine).

Dual-energy x-ray absorptiometry) machines will eventually report results in terms of FRAX. Meanwhile, clinicians can use an online calculator. Though the site is in the United Kingdom, it lists four tools customized for Americans based on race.

The new guidelines also update recommendations for vitamin D and calcium: Adults older than age 50 should get 1,200 mg of calcium a day, whether from diet or supplements, and 800-1,000 IU of vitamin D3, up from an earlier recommendation of 400-600 IU.

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