골다공증 -Clinical risk factors for fracture - screening recommendations

Clinical risk factors for fracture

 

1.Advancing age

2.Previous fracture

3.Glucocorticoid therapy

 

4.Parental history of hip fracture

5.Low body weight

6.Current cigarette smoking

 

7.Excessive alcohol consumption

8.Rheumatoid arthritis

9.Secondary osteoporosis

(eg, hypogonadism or premature menopause,

malabsorption, chronic liver disease, inflammatory bowel disease)

 

 

 

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Osteoporosis screening recommendations

National Osteoporosis Foundation (NOF)

The NOF recommends measurement of BMD (DXA of the hip and spine) in[1]:

• Women aged 65 years and older and men age 70 and older, regardless of clinical risk factors

• Younger postmenopausal women, 

women in the menopausal transition, 

and men age 50 to 69 with clinical risk factors for fracture

• Adults who have a fracture after age 50

• Adults with a condition (eg, rheumatoid arthritis) or 

taking a medication (eg, glucocorticoids in a daily dose ≥5 mg prednisone or equivalent for ≥3 months) 

associated with low bone mass or bone loss

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International Society for Clinical Densitometry (ISCD)

The ISCD recommends measurement of BMD (DXA of the hip and spine) in[2]:

• All women 65 years and older and men 70 and older regardless of risk factors

• Postmenopausal women and men 50 to 70 years when risk factors are present

• Adults with a fragility fracture

• Adults with a condition or taking a medication associated with low bone mass or bone loss

• Anyone being considered for pharmacologic therapy for osteoporosis

• Anyone being treated for osteoporosis to monitor response to therapy

• Anyone not receiving therapy when evidence of bone loss would lead to treatment

• Women in the menopausal transition 

if there is a specific risk factor associated with increased fracture, 

such as low body weight, prior low-trauma fracture, 

or high risk medication

• Postmenopausal women discontinuing estrogen should be considered for bone density testing

• The 33 percent forearm (1/3 radius) site is recommended in the following cases:

- If hip and/or spine cannot be measured or interpreted

- Hyperparathyroidism

- Severe obesity (over the weight limit of DXA table)

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Association of Clinical Endocrinologists (AACE)

AACE recommends measurement of BMD (DXA) in[4]:

• All women 65 years and older

• Any adult with a history of fracture not caused by severe trauma

• Younger postmenopausal women with clinical risk factors for fracture

• The lumbar spine (PA) and proximal femur are recommended sites of measurement

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United States Preventive Services Task Force (USPSTF)

USPSTF recommends measurements of BMD in[5]:

• All women ages 65 and older

• In addition, they recommend screening in younger women 

whose fracture risk is equal to or greater than 

that of a 65-year-old white woman who has no additional risk factors

• The best site to screen is not mentioned, 

although the report agrees that DXA of the hip is the best predictor of hip fracture

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American Academy of Family Physicians

The American Academy of Family Physicians recommends measurement of BMD in[6]:

• Women ages 65 and older

• Women 60 and older at increased risk for osteoporotic fracture

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National Institutes of Health

The NIH recommends[7]:

• BMD measurements for individuals at high risk for osteoporosis. 

They do not recommend universal screening.

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UK National Osteoporosis Guideline Group (NOGG)

The UK National Osteoporosis Guideline Group (NOGG) 

does not recommend population screening. 

They are in favor of performing BMD measurements 

using a case finding strategy 

based upon age-specific fracture probability thresholds[8].

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Canadian Osteoporosis Society

The Canadian Osteoporosis Society recommends BMD measurement in[9]:

• Postmenopausal women ≥65 years

• Men ≥65 years

• Younger men and women with additional clinical risk factors for fracture