National Osteoporosis Foundation Releases New Clinical Recommendations for Low Bone Mass and Osteoporosis Incorporating Absolute Fracture Risk

Washington, DC (February 21, 2008) – The National Osteoporosis Foundation (NOF) is releasing its new Clinician’s Guide to Prevention and Treatment of Osteoporosis representing a major breakthrough in the way healthcare providers evaluate and treat people with low bone mass or osteoporosis and the risk of fractures. NOF’s new Clinician’s Guide introduces guidelines beyond Caucasian postmenopausal women to include African-American, Asian, Latina and other postmenopausal women, and addresses men age 50 and older for the first time. 

Osteoporosis is a major public health problem that has both a medical and economic impact in the U.S. Fractures caused by either osteoporosis or low bone mass can lead to chronic pain, disability and even death, as well as psychological symptoms, including depression. Each year broken bones due to low bone mass or osteoporosis cause over 432,000 hospital admissions, almost 2.5 million medical office visits and about 180,000 nursing home admissions.

“NOF’s new Clinician’s Guide dramatically alters the approach to assessing fracture risk and treatment,” said Bess Dawson-Hughes, M.D., chair of the Clinician’s Guide Development Committee and past president of NOF. “The Guide provides evidenced-based recommendations to help healthcare providers better identify people at high risk for developing osteoporosis and fractures and assures that those at highest risk are recommended for treatment to lower that risk.” 

The new Clinician’s Guide applies the recently released algorithm on absolute fracture risk called FRAX® by the World Health Organization (WHO). FRAX® is also referred to as a 10-year fracture risk model and 10-year fracture probability. This algorithm estimates the likelihood of a person to break a bone due to low bone mass or osteoporosis over a period of 10 years. 

Absolute fracture risk methodology provides a markedly improved method to assure that people with the highest fracture risk get treated. Those at highest risk include postmenopausal women and older men with a diagnosis of osteoporosis, based on a BMD test T-score of -2.5 or lower, or those with a clinical diagnosis based on having sustained a hip or spine fracture. In addition, absolute fracture risk calculations help to resolve many of the questions about management for people with low bone mass, also called osteopenia. These are people with a T-score between -1.0 and -2.5 on their bone mineral density (BMD) test. 

The WHO algorithm takes into account not only bone mineral density (BMD) at the hip but also nine specific clinical risk factors for osteoporosis and related fractures. NOF has adapted this algorithm for the U.S. and incorporates not only fracture outcome and mortality data from U.S. women and men, but also cost effectiveness analysis to determine when it is cost effective to treat a person with an osteoporosis medication to prevent a fracture. 

“In developing the new Clinician’s Guide, NOF is providing healthcare professionals in the U.S. with the newest advances for diagnosing and managing osteoporosis,” said Ethel Siris, M.D., president of the National Osteoporosis Foundation. “To be able to better identify and treat those patients at risk for osteoporosis and costly fractures will have a positive impact on the medical, emotional and economic burden that osteoporosis bears on this country.”

In the near future, some central DXA (dual-energy x-ray absorptiometry) machines that test the bone mineral density of the hip and spine should be able to provide a report that gives information on a person’s absolute fracture risk by incorporating the NOF application of the WHO algorithm into the bone density machine’s computer. Alternatively, clinicians can also enter a patient’s bone mineral density hip T-score and other risk factor information in a simple web-based version of the algorithm in the doctor’s office to obtain absolute fracture risk in seconds. The information about absolute fracture risk will help both healthcare providers and patients decide whether treatment with an osteoporosis medication is needed.

The new Clinician’s Guide also provides recommendations for clinicians on when to do bone mineral density testing, clinical evaluation, risk factors for falls and universal recommendations for the prevention of osteoporosis. NOF summarizes the universal recommendations in its 5 Steps to Bone Health. These 5 Steps advise people to:
1. Get the daily recommended amounts of calcium and vitamin D.
2. Engage in regular weight-bearing and muscle-strengthening exercise.
3. Avoid smoking and excessive alcohol.
4. Talk to your healthcare provider about bone health.
5. Have a bone density test and take medication when appropriate.

The new Clinician’s Guide recommends that adults over age 50 get 1,200 mg of calcium and 800-1,000 IU of vitamin D3 daily. Vitamin D3 is the form of vitamin D that best supports bone health. It is also called cholecalciferol. 

The Clinician’s Guide was developed by an expert committee of NOF in collaboration with a multi-specialty council of medical experts in the field of bone health convened by NOF. The Clinician’s Guide provides recommendations that are intended to serve as a reference for clinical decision making with individual patients. The recommendations are not intended to be rigid standards, limits or rules and should not be interpreted as quality standards. Earlier versions of the updated Clinician’s Guide to Prevention and Treatment of Osteoporosis were called the Physician’s Guide to Prevention and Treatment of Osteoporosis.

Established in 1984, the National Osteoporosis Foundation is the nation’s leading voluntary health organization solely dedicated to osteoporosis and bone health. Our mission is to prevent osteoporosis, to promote lifelong bone health, to help improve the lives of those affected by osteoporosis and related fractures, and to find a cure. For more information on osteoporosis and bone health, contact NOF online at www.nof.org or by telephone (800) 223-9994.