Post on 04-Jul-2015
transcript
OSTEOPOROSIS: EPIDEMIOLOGY AND DIAGNOSIS
Dilek Gogas Yavuz,MD
Marmara University School of Medicine Section of Endocrinology and Metabolism
Istanbul ,Turkey
Endo Bridge 2013
Silent disease until complicated by fractures
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
Definition of osteoporosis
A skeletal disorder characterized by
Compromised bone strength
An increased risk of fracture
NIH Consensus Development Conference, March 2000
Bone strength =bone density+ bone quality
normal osteoporosis
Low bone mass and microarchitectural deterioration
• 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
Osteoporosis Is a Serious Public Health Problem
Every 3 second an osteoporotic fracture occcur
only 10 to 20% are diagnosed and treated
Prevalance of osteoporosis in men and women by gender-spesific scores
Schuit et al. Bone 2004;34:195
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
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
Prevalance of Osteoporosis
At age 50 lifetime risk of
fracture is
1:2 women 1:5 men
Osteoporotic Fractures in Women: Comparison with Other Diseases
Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society
1 500 000*
0
500
1000
1500
2000
Osteoporotic Fractures
*annual incidence all ages † annual estimate women 29+ ‡annual estimate women 30+ •1996 new cases, all ages
513 000†
228 000‡ 184 300•
750 000 vertebral
250 000 other sites
250 000 forearm
250 000 hip
Heart Attack
Stroke Breast Cancer
An
nu
al i
nci
de
nce
x 1
00
0
Risk of osteoporotic fracture in 1 year is greater than combined risk of heart attack, stroke, and
breast cancer.
Hip fracture incidence alone exceeds that of breast cancer.
Cooper C, Melton LJ. Trends Endocrinol Metab. 1992;3:224–229.
Osteoporotic Fractures in Men and Women
4,000
3,000
2,000
1,000
35–39 > 85 > 85
Age Group, yr
Inci
den
ce/1
00
,00
0 P
erso
n-Y
ear
Men Women
Hip
Hip
Vertebrae Vertebrae
Colles’ Colles’
35–39
As with women, hip fractures in men increase dramatically with age
Distribution of Fractures
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
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
WHO criteria for diagnosis of osteoporosis
T score
normal -1.0 and above
osteopenia -1.0 and -2.5
osteoporosis -2.5 and below
Severe (established) osteoporosis
-2.5 and below ,plus one
or more osteoporotic fracture(s)
T-score : Difference expressed as standard deviation compared to young reference population
Kanis et al. J Bone Mineral Res 1994;9:1137
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
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.
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
BMD and fracture risk
• 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
10 –year probability of hip fracture in women according to age and T-score for femoral neck BMD
Osteoporosis int 2013,24:23-57
BMD alone is less optimal as an intervantion
For any BMD, fracture risk higher in the elderly than in the young
Clinical Risk Factors that Affect Fracture Risk
Fractures and weight
Compston JE et al. Am J Med 2011;124:1043
Fracture risk assessment Risk engines
• Garvan fracture risk calculator
• Q fracture
• FRAX
Relative fracture risk BMD 10-year absolute fracture risk Risk Engines
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 bone-protective therapy
Categorization Based on 10-year Fracture Risk
Absolute fracture risk in 10 years:
low: <10%
moderate: 10-20%
high: >20%
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.
Ostoeporosis is a serios health problem
Osteoporotic fractures are expected to rise
Lack of awareness
Risk assesment
Prevenion of fractures
Thank you