Bone density is only one part of the story
We have long known that there are factors other than bone density that affect a person’s risk of having a fracture. Age is the most important factor; at the same level of bone density. Older people have much higher fracture risk. If someone has had a fracture, then the risk of having another is nearly doubled. A number of medical problems can contribute to fracture risk: being very thin, smoking, drinking heavily, having rheumatoid arthritis, and taking cortisone-like drugs all may play a role. This interplay of clinical risk factors explains why more than half of patients who have osteoporotic-type fractures (due to relatively minor injury) do not have very low bone density values in the osteoporosis range.
Measuring your risk for having a fracture
Researchers working with the World Health Organization developed a method to measure the likelihood of someone fracturing in the future. Using a combination of clinical risk factors, we can now estimate the probability that a person will have a fracture of the spine, hip, shoulder or wrist over the next 10 years.1
The purpose of treating patients is to reduce the chance of having a new fracture
The drugs that we now have are very effective in decreasing the likelihood of having new fractures; they reduce risk by at least one-third. However, because these medicines have costs, inconveniences, and possible (though infrequent) side effects, it is important for doctors to identify the patients who will most likely benefit from treatment. Not only is it a better use of our resources to treat people at higher risk, but, surprisingly, patients at high risk of fracture benefit much more from treatment than those at low risk. Using a fracture risk tool, doctors will move away from treating just the T-score and will be able to target therapy toward patients with moderate and high risk who will receive the most benefit from the drugs.2
Prevention is always important — despite your risk
You must get adequate calcium and vitamin D, exercise regularly, quit smoking, and think about how to reduce falls. And if your doctor prescribes bone-strengthening medications, take it regularly and the right way.
(1) Kanis, JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet, 2002; 359:1929-36.
(2) McClung, MR Do current management strategies and guidelines adequately address fracture risk? Bone. 2006; 38: S13- S17.
Posted: 12/5/2016; Revised: 01/13/20.
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