The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group

被引:724
作者
Siris, E. S. [1 ]
Adler, R. [2 ]
Bilezikian, J. [1 ]
Bolognese, M. [3 ]
Dawson-Hughes, B. [4 ]
Favus, M. J. [5 ]
Harris, S. T. [6 ]
Jan de Beur, S. M. [7 ]
Khosla, S. [8 ]
Lane, N. E. [9 ]
Lindsay, R. [10 ]
Nana, A. D. [11 ]
Orwoll, E. S. [12 ]
Saag, K. [13 ]
Silverman, S. [14 ]
Watts, N. B. [15 ]
机构
[1] Columbia Univ, Med Ctr, Dept Med, Div Endocrinol, New York, NY 10027 USA
[2] Virginia Commonwealth Univ, Sch Med, Richmond, VA USA
[3] Bethesda Hlth Res, Bethesda, MD USA
[4] Tufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Bone Metab Lab, Boston, MA USA
[5] Univ Chicago, Dept Med, Chicago, IL 60637 USA
[6] Univ Calif San Francisco, Dept Endocrinol & Metab, San Francisco, CA 94143 USA
[7] Johns Hopkins Univ, Div Endocrinol, Baltimore, MD USA
[8] Mayo Clin, Rochester, MN USA
[9] Univ Calif Davis, Sch Med, Davis, CA 95616 USA
[10] Helen Hayes Hosp, W Haverstraw, NY USA
[11] Univ N Texas, Hlth Sci Ctr, Ft Worth, TX USA
[12] Oregon Hlth & Sci Univ, Portland, OR 97201 USA
[13] Univ Alabama Birmingham, Div Clin Immunol & Rheumatol, Birmingham, AL 35294 USA
[14] Cedars Sinai Med Ctr, Bone Hlth Ctr, Los Angeles, CA 90048 USA
[15] Mercy Hlth Phys, Osteoporosis & Bone Hlth Serv, Cincinnati, OH USA
关键词
Clinical diagnosis; Criteria; Osteoporosis; Position statement; MINERAL DENSITY; POSTMENOPAUSAL WOMEN; ZOLEDRONIC ACID; UNITED-STATES; HIP FRACTURE; RISK; THRESHOLDS; THERAPY;
D O I
10.1007/s00198-014-2655-z
中图分类号
R5 [内科学];
学科分类号
100201 [内科学];
摘要
Osteoporosis causes an elevated fracture risk. We propose the continued use of T-scores as one means for diagnosis but recommend that, alternatively, hip fracture; osteopenia-associated vertebral, proximal humerus, pelvis, or some wrist fractures; or FRAX scores with a parts per thousand yen3 % (hip) or 20 % (major) 10-year fracture risk also confer an osteoporosis diagnosis. Osteoporosis is a common disorder of reduced bone strength that predisposes to an increased risk for fractures in older individuals. In the USA, the standard criterion for the diagnosis of osteoporosis in postmenopausal women and older men is a T-score of a parts per thousand currency signaEuro parts per thousand a'2.5 at the lumbar spine, femur neck, or total hip by bone mineral density testing. Under the direction of the National Bone Health Alliance, 17 clinicians and clinical scientists were appointed to a working group charged to determine the appropriate expansion of the criteria by which osteoporosis can be diagnosed. The group recommends that postmenopausal women and men aged 50 years should be diagnosed with osteoporosis if they have a demonstrable elevated risk for future fractures. This includes having a T-score of less than or equal to -2.5 at the spine or hip as one method for diagnosis but also permits a diagnosis for individuals in this population who have experienced a hip fracture with or without bone mineral density (BMD) testing and for those who have osteopenia by BMD who sustain a vertebral, proximal humeral, pelvic, or, in some cases, distal forearm fracture. Finally, the term osteoporosis should be used to diagnose individuals with an elevated fracture risk based on the World Health Organization Fracture Risk Algorithm, FRAX. As new ICD-10 codes become available, it is our hope that this new understanding of what osteoporosis represents will allow for an appropriate diagnosis when older individuals are recognized as being at an elevated risk for fracture.
引用
收藏
页码:1439 / 1443
页数:5
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