National Bone Health Alliance Clinical Diagnosis of Osteoporosis Working Group Position Paper Published by Osteoporosis International

WASHINGTON, March 19, 2014 /PRNewswire-USNewswire/ -- The National Bone Health Alliance (NBHA) Clinical Diagnosis of Osteoporosis Working Group recommends expanding the criteria for making a diagnosis of osteoporosis to include all post-menopausal women and all men age 50 and over who are demonstrated to have an  elevated risk for fracture. The group's recommendations are detailed in a position paper recently published online by Osteoporosis International (available at http://link.springer.com/article/10.1007/ s00198-014-2655-z).

Osteoporosis is a disease in which an individual's bones become weaker and more likely to break after minor trauma. The disease is responsible for an estimated two million broken bones per year, yet nearly 80 percent of older Americans who suffer bone breaks are not tested or treated for osteoporosis. The U.S. currently spends over $19 billion annually to treat fractures and the cost is projected to rise to more than $25 billion by 2025. Yet, the majority of patients who suffer from a fracture are released without being evaluated for osteoporosis – the underlying disease which likely led to the fracture. 

"Identifying people at risk for fracture helps prevent future fractures, which is the key to sparing many older Americans from the pain, suffering and reduced quality of life  associated with broken bones and producing enormous cost savings for the healthcare system," said Ethel Siris, MD, director of the Toni Stabile Osteoporosis Center at Columbia University Medical Center, New York Presbyterian Hospital, chair of the NBHA Clinical Diagnosis of Osteoporosis Working Group, and member of the NBHA executive committee. "By expanding the clinical diagnosis of osteoporosis, our goal is to create a new understanding of what the disease represents, allowing older adults with an increased risk for fracture to be appropriately diagnosed and treated for osteoporosis, and to ensure those adults who clearly suffer from osteoporosis are diagnosed."

The standard criterion today for diagnosing osteoporosis among post-menopausal women and older men in the U.S. is a T-score of less than or equal to -2.5 at the spine or hip as measured by bone mineral density (BMD) testing. The NBHA working group recommends continuing to use T-scores as one method for diagnosis, but expands the criteria to allow a diagnosis for individuals who have experienced a hip fracture and those with osteopenia (low bone mass) who suffer a spine fracture, shoulder fracture,  pelvis fracture, and in some cases wrist fracture.  Having any of these fractures after minimal trauma is associated with a high risk of additional future fractures.

The group also recommends using the term osteoporosis to diagnose individuals who have an elevated fracture risk based on the World Health Organization Fracture Risk Assessment Tool (FRAX), which calculates a person's 10-year fracture risk and is recommended to assess that risk in people whose BMD test show osteopenia.

The NBHA working group, made up of 16 clinicians and clinical scientists charged with determining the appropriate expansion of the criteria used to diagnose osteoporosis, will now work to engage with medical societies, Medicare and other payers to gain endorsement of the expanded clinical diagnosis of osteoporosis.

"Many have argued that older individuals who suffer a hip or vertebral fracture should be diagnosed with osteoporosis, with or without meeting the current criteria of a T-score that is -2.5 or lower," said Keith Hruska, MD, professor of pediatrics, medicine and cell biology, Washington University/St. Louis Children's Hospital, co-chair, National Bone Health Alliance and past president, American Society for Bone and Mineral Research. "If the group's expanded definition of osteoporosis is widely endorsed, it will serve as a means to educate the health care community on osteoporotic fractures and ensure those patients who clearly have osteoporosis or have suffered from a fracture caused by osteoporosis are diagnosed correctly. This will help reduce the current nearly 80 percent fracture care gap in the U.S."

About the National Bone Health Alliance
Established in late 2010, the National Bone Health Alliance is a public-private partnership that brings together the expertise and resources of various partners across a broad spectrum to promote bone health and prevent disease; improve diagnosis and treatment of bone disease; and enhance bone research, surveillance and evaluation. The NBHA is a platform that allows all voices in the bone health community to work together around shared priorities and develop projects that can become reality through pooled funding. The 52 members of the Alliance (in addition to liaisons representing the Centers for Disease Control and Prevention, National Aeronautics and Space Administration, National Institutes of Health and U.S. Food and Drug Administration) are working from a shared vision: to improve the overall health and quality of life of all Americans by enhancing their bone health. For more information on the NBHA, visit www.nbha.org.

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SOURCE National Bone Health Alliance