New clinical recommendations for low bone mass and osteoporosis

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The latest version of the Clinician'sGuide to Prevention and Treatment of Osteoporosis, updated by the National Osteoporosis Foundation (NOF) earlier this year, represents a major breakthrough in the evaluation and treatment of persons who have low bone mass or osteoporosis, according to the organization. The guide provides evidence-based recommendations to help physicians better identify persons at high risk for osteoporosis and fractures and ensure that they are recommended for treatment. It introduces guidelines that address African American, Asian, Latina, and other postmenopausal women-and men aged 50 years and older-as well as white postmenopausal women.

The NOF guide uses new absolute fracture risk methodology as the basis for treatment decisions. The information is based on a World Health Organization (WHO) report detailing an absolute fracture risk algorithm (FRAX) that estimates the likelihood that a person will break a hip or other major bone because of low bone mass or osteoporosis in a 10-year period. In addition to providing a markedly improved evaluation method, the absolute fracture risk calculations help resolve many treatment questions for persons with low bone mass. The recommendations are intended to serve as a reference for clinical decision making with individual patients rather than as rigid rules or quality standards.

The WHO algorithm takes into account bone mineral density (BMD) at the hip and 9 specific clinical risk factors for osteoporosis and related fractures (eg, current age, sex, personal history of a fracture, and low body mass index). It incorporates fracture outcome and mortality data from US women and men with an analysis of cost-effectiveness for using an osteoporosis medication to prevent a fracture.

Some central dual-energy x-ray absorptiometry machines that test hip and spine BMD may provide a report with information on a person's absolute fracture risk by incorporating the NOF application of the WHO algorithm into the BMD machine's computer. Clinicians also may be able to enter a patient's BMD hip T-score and other risk factor information in a simple Web-based version of the algorithm in the office to obtain absolute fracture risk within seconds and decide whether treatment with an osteoporosis medication is needed.

The updated guide also provides universal osteoporosis prevention recommendations for patients. They include the following:

• Take the recommended amounts of calcium and vitamin D (for adults older than 50 years, 1200 mg/d of calcium and 800 to 1000 IU/d of vitamin D₃).

• Engage in regular weight-bearing and muscle strengthening exercise.

• Avoid cigarette smoking and excessive alcohol intake.

• Talk to your physician about bone health.

• Undergo a bone density test and, when appropriate, take medication.

For more information on osteoporosis and bone health, visit the NOF Web site at www.nof.org. Or, contact the organization at National Osteoporosis Foundation, 1232 22nd Street NW, Washington, DC 20037-1202; telephone (toll-free): (800) 223-9994.