osteoporosis epidemiology and diagnosis

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osteoporosis epidemiology and diagnosis

  1. 1. Endo Bridge 2013 OSTEOPOROSIS: EPIDEMIOLOGY AND DIAGNOSIS Dilek Gogas Yavuz,MD Marmara University School of Medicine Section of Endocrinology and Metabolism Istanbul ,Turkey
  2. 2. Silent disease until complicated by fractures
  3. 3. Osteoporosis: silent epidemic 385 pts with fragility fractures Have you ever heard of osteoporosis? NO:20% YES:80% Do you think that the fracture you have experienced could be due to fragility of your bones? NO:73 % YES:27 % Chavalley et al. Osteoporosis Int 2002;13:450
  4. 4. Definition of osteoporosis NIH Consensus Development Conference, March 2000 A skeletal disorder characterized by  Compromised bone strength  An increased risk of fracture Bone strength =bone density+ bone quality normal osteoporosis Low bone mass and microarchitectural deterioration
  5. 5. Osteoporosis Is a Serious Public Health Problem Every 3 second an osteoporotic fracture occcur • Worldwide, osteoporosis causes more than 8.9 million fractures annually • Osteoporosis affects an estimated 75 million people in Europe, USA and Japan, 2.2 million in Australia, 70 million in China only 10 to 20% are diagnosed and treated
  6. 6. Prevalance of osteoporosis in men and women by gender-spesific scores Osteoporosis is estimated to affect 200 million women worldwide approximately one-tenth of women aged 60, one-fifth of women aged 70, two-fifths of women aged 80 and two-thirds of women aged 90 Schuit et al. Bone 2004;34:195
  7. 7. Prevalance of Osteoporosis  Over 50% of women and 30-45% of men over age 50 have osteopenia/osteoporosis  Men over age 60 has 25% risk osteoporotic fracture  70% over age 80 have osteoporosis At age 50 lifetime risk of fracture is 1:2 women 1:5 men
  8. 8. Osteoporotic Fractures in Women: Comparison with Other Diseases 2000 *annual incidence all ages estimate women 29+ ‡annual estimate women 30+ •1996 new cases, all ages Annual incidence x 1000 † annual 1500 1000 1 500 000* 250 000 hip 250 000 forearm 250 000 other sites 513 000† 500 0 750 000 vertebral Osteoporotic Fractures 228 000‡ Heart Attack Risk of osteoporotic fracture in 1 year is greater than combined risk of heart attack, stroke, and breast cancer. 184 300• Stroke Breast Cancer Hip fracture incidence alone exceeds that of breast cancer. Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society
  9. 9. Osteoporotic Fractures in Men and Women As with women, hip fractures in men increase dramatically with age Distribution of Fractures Cooper C, Melton LJ. Trends Endocrinol Metab. 1992;3:224–229.
  10. 10. Consequences of fractures • Death 10%-20% inrease in mortality with hip fractures • Disability hip fractures 20% of patients require long-term nursing home care 60% of patients fail to return to prefracture level of function vertabral fractures chronic back pain,kyphosis,height loss, impaired pulmonary function • Reduced quality of life • Loss of independence Clinician’s Guide To The Prevention And Treatment Of Osteoporosis US Department Of Health And Human Sciences
  11. 11. Diagnosis of Osteoporosis • Based on T score (T Score : standart deviation by which the individual’s BMD differs from the mean value expected in young healthy individuals) • Operational definition of osteoporosis: BMD -2.5 SD or more below the Young female adult mean • Reference technique :DXA • Reference site: femoral neck • Applies to men and to women Osteoporosis international 2013;24:23-57
  12. 12. WHO criteria for diagnosis of osteoporosis T-score : Difference expressed as standard deviation compared to young reference population T score normal osteopenia osteoporosis -1.0 and above -1.0 and -2.5 -2.5 and below Severe (established) osteoporosis -2.5 and below ,plus one or more osteoporotic fracture(s) Kanis et al. J Bone Mineral Res 1994;9:1137
  13. 13. WHO classification with a T-score cannot be applied to: • premenopausal women • men under age 50 • children Z score Low Z-score (less than -2.0) has been suggested by some to increase likelihood of secondary osteoporosis
  14. 14. Who Should Have a Bone Density Test?  Women age 65 and older and men age 70 and older  Younger postmenopausal women and men ages 50–69 with clinical risk factors  Adults who have a fracture after age 50  Adults with a condition (e.g., rheumatoid arthritis) or taking a medication (e.g., glucocorticoids) associated with low bone mass or bone loss 1. Sweet MG, et al. Am Fam Physician. 2009;79(3):193-200. 2. National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. www.nof.org. Accessed February 2013.
  15. 15. BMD measurements to predict future fracture risk has a high specificity but a low sensitivity Most women with hip fractures do not have a T score < -2.5 Wainwright et al JCEM 2005;90:2787
  16. 16. BMD and fracture risk BMD alone is less optimal as an intervantion • The fracture risk varies markedly in different countries ,but T-score varies by a small amount • Any given T-score to fracture risk in women from any one country Depends on age • Fracture risk depends of clinical risk factors For any BMD, fracture risk higher in the elderly than in the young 10 –year probability of hip fracture in women according to age and T-score for femoral neck BMD Osteoporosis int 2013,24:23-57
  17. 17. Clinical Risk Factors that Affect Fracture Risk
  18. 18. Fractures and weight Compston JE et al. Am J Med 2011;124:1043
  19. 19. Fracture risk assessment Risk engines Relative fracture risk BMD 10-year absolute fracture risk Risk Engines • Garvan fracture risk calculator • Q fracture • FRAX
  20. 20. FRAX • Computer -based algorithm (http://www.shef.ac.uk/FRAX) • Objective: To estimate fracture risk in order to help with treatment decisions • Rationale: BMD+CRFs predict fracture risk better than either alone • Calculates the 10 year probability of a major fracture (hip, clinical spine,humerus,wrist) and 10-year probability of hip fracture • designed only for postmenopausal women and men over the age of 40 who have not previously received boneprotective therapy
  21. 21. Categorization Based on 10-year Fracture Risk Absolute fracture risk in 10 years: low: <10% moderate: 10-20% high: >20%
  22. 22. Limitations of FRAX™ WHO Fracture Probability Tool  Not valid in patients on treatment  Only hip BMD is considered  Risk is “yes/no” – there is no consideration of “dose” (e.g., fractures, glucocorticoids, smoking, alcohol)  Not all risk factors are included (e.g., falls)  “Major osteoporotic fracture” is not the same as all osteoporotic fractures  Clinical judgment is required Watts NB, et al. J Bone Miner Res 2009;24:975-979.
  23. 23.  Ostoeporosis is a serios health problem  Osteoporotic fractures are expected to rise  Lack of awareness  Risk assesment  Prevenion of fractures
  24. 24. Thank you

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