January 2006 · Vol. 18, No. 1Osteopenia:
When to intervene?
Why fracture risk assessment should rely on a constellation of factors—not just a numerical bone-density value
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Fast Track
If we are to prevent fractures, we cannot simply wait until women have osteoporosis to treat them
The absolute fracture risk of a 50-year-old woman with a T score of –3 is exactly the same as that of an 80-year-old woman with a T score of –1
Parathyroid hormone analog builds new bone. Estrogen, bisphosphonates, and SERMs retard resorption
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MORE trial The prevalence of fractures (not rate) is far greater with osteopenia
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Rotterdam trial 12% of nonvertebral fractures were in women with normal BMDs
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NORA trial Of postmenopausal women who suffered a new fracture within 1 year, 82% had osteopenia
4 top predictors of a fracture within 1 year9
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Previous fracture, regardless of T score
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T score worse than –1.8
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Poor health
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Poor mobility
In the works: A formula to calculate the level of risk at which to start bone drugs
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Steven
R.
Goldstein,
MDProfessor of Obstetrics and Gynecology, New York University School of Medicine,
New York City
In the decade or so since the World Health Organization (WHO) first characterized the terms osteoporosis and osteopenia, basing them on bone-density measurements from dual-energy x-ray absorptiometry (DXA), we have come to know the definitions well, thanks to attention in the lay and medical press (TABLE 1).1
What is the goal behind the heightened public awareness? To reduce the number of osteoporotic fractures.
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