SAN DIEGO – Osteoporosis management is about to undergo some changes, including a new international focus on assessing fracture risk in clinical practice and an emphasis on vitamin D, Dr. Stuart L. Silverman predicted at the Perspectives in Women's Health conference, sponsored by FAMILY PRACTICE NEWS, OB.GYN. NEWS, and INTERNAL MEDICINE NEWS.
“We're changing the whole way we approach osteoporosis in 2008,” said Dr. Silverman, with the International Working Group on Fracture Risk Assessment for the World Health Organization.
New guidelines will encourage the calculation of fracture risk based not only on their bone mineral density and T score, but also on age, body mass index, family history, and other factors, he explained.
This composite fracture score, expected to be incorporated into software linked with dual-energy x-ray absorptiometry (DXA) equipment by late 2008, will provide a much more comprehensive and easy-to-understand risk profile, he said.
“You will get a printout that says your patient has, [for example], a 10-year risk of hip fracture of 3%,” said Dr. Silverman, of the division of rheumatology at Cedars-Sinai Medical Center in Los Angeles.
The calculated 10-year risk for clinical fracture of the shoulder, forearm, or vertebra will be included in a separate score.
Factors in the 10-year predictions of fracture risk include:
▸ Age, which can change the 10-year risk for a woman with a T score of −2.5 at the femoral neck from 2% at age 50 to 12.5% at age 80.
▸ History of prior fragility fracture, which increases fracture risk fivefold.
▸ Low body weight/BMI.
▸ History of a hip fracture in the patient's mother or father.
▸ Lifetime history of ever using corticosteroids at a dose of 5 mg/day or greater for 3 months or longer.
▸ Current smoking.
▸ Consumption of more than two alcoholic drinks per day.
▸ Secondary osteoporosis caused by a disease process or a drug.
“Your goal is not to reduce risk of osteoporosis, but to reduce the risk of fracture,” Dr. Silverman said.
One way that risk can be reduced is through vitamin D supplementation recommendations, which are also likely to change soon, according to Dr. Silverman.
“Recently we've all come to appreciate that we really need much more vitamin D,” he said. “We're pushing for 800 to 1,000 IU day, and I will tell you that a lot of us in the field … are actually taking more than that,” he added.
New studies show vitamin D is useful not only for bones, but for balance and for reducing overall cancer risk, he noted.
RHEUMATOLOGY NEWS, like FAMILY PRACTICE NEWS, OB.GYN. NEWS, and INTERNAL MEDICINE NEWS, is published by the International Medical News Group, a division of Elsevier.