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Year : 2010  |  Volume : 3  |  Issue : 3  |  Page : 124-130


WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK

Correspondence Address:
John A Kanis
WHO Collaborating Centre for Metabolic Bone Diseases University of Sheffield Medical School Beech Hill Road, Sheffield S10 2RX
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Source of Support: None, Conflict of Interest: None

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The clinical significance of osteoporosis lies in the fractures that arise, but the diagnosis of osteoporosis relies on the quantitative assessment of bone mineral density. There are a number of other indications for bone densitometry including monitoring of treatment, determining the extent of bone loss and assessment of suitability for certain treatments. Most commonly, bone density is used to determine eligibility for treatment. However, diagnostic thresholds differ from intervention thresholds for several reasons. Firstly, the fracture risk varies at different ages, even with the same T-score. Other factors that determine intervention thresholds include the presence of clinical risk factors such as a prior fracture, a family history of hip fracture, smoking and high alcohol consumption and secondary causes of osteoporosis. Algorithms that integrate the weight of clinical risk factors for fracture risk have been developed by the World Health Organization. This FRAX® tool (www.shef.ac.uk/FRAX) computes the 10-year probability of hip fracture or a major osteoporotic fracture (clinical spine, hip, forearm or humerus). Probability-based intervention thresholds are now being incorporated into new management guidelines that integrate FRAX® with clinical management algorithms.

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