Osteoporosis, Fracture Prevention and Falls Risk Assessment – Closing the Gap between Treatment Guidelines and Clinical Practice

Yasser El Miedany, Mathias Toth
European Musculoskeletal Review, 2011;6(1):14-17
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Abstract

Abstract
Osteoporosis is a common disease that is associated with significant morbidity and mortality, the prevalence of which is expected to increase in an ageing population. We know that bone mineral density (BMD) measurements, while valuable, may not provide sufficient information to enable us to identify all patients at high risk of fracture. Furthermore, earlier studies revealed that approximately one-half of osteoporotic fractures occurred in women with a T-score above -2.5. If our aim is to prevent fractures, it is not acceptable just to wait until women have developed osteoporosis and then start treating them. Our ability to predict the risk of fractures can be improved by adding clinical risk factors that contribute to fracture risk independently of BMD. Combined assessments of clinical risk factors for osteoporosis/BMD measurement and fracture risk probability, as well as falls risk, form the main three factors guiding the decision as to whether to initiate osteoporosis therapyand when to reassess. The ‘risk factors assessment strategy’ approach is the best way to identify individual patients who are at high risk for fracture and this may have important clinical implications for their management. This raises the question as to how this risk stratification canbe implemented in clinical practice. This article discusses how risk assessments for osteoporosis, falls and fractures can be handled together in standard clinical practice as three confounders in one equation.

Keywords
Osteoporosis, fracture risk assessment tool (FRAX), falls, dual-energy x-ray absorptiometry, falls risk assessment score (FRAS), osteoporosis and falls risk assessment (OPOFRA)

Disclosure: The authors have no conflicts of interest to declare.
Received: 11 July 2010 Accepted: 6 January 2011 Citation: European Musculoskeletal Review, 2011;6(1):14–7

Correspondence: Yasser El Miedany, Darent Valley Hospital, Dartford, DA2 8DA, Kent, UK. E: yasser_elmiedany@yahoo.com

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