DEXA management for the diagnosis of osteoporosis – a worldwide perspective: Part 2
In a separate calculation differences in prediction of hip fracture were studied (O. Johnell and J.A. Kanis, personal communication), whether lumbar spine BMD measurement had the same predictive ability as femoral neck BMD measurement and if the combination of femoral neck BMD and lumbar spine BMD could increase the predictive ability. The data show that for hip fracture BMD at the hip had a better predictive ability than the lumbar spine measurements and that combination of lumbar spine BMD and femoral neck BMD did not contribute to an increased predictive ability.
The problem with BMD is also that the absolute values differ between the types of scanner but an algorithm has been created to get a standardized BMD for the different scanners (Kanis et al., 2002b). This is necessary to make an easy calculation for the T score. As mentioned earlier, the diagnosis and the intervention threshold should be divided (Kanis et al., 2002b). Therefore focus on risk assessment for intervention threshold with BMD measurements and other risk factors should be done. The prevalence of osteoporosis is somewhat different in the published studies in that there are more osteoporotic patients in some countries, partly depending on the reference population, whether it is from the local area or from the manufacturer. Therefore we should shift focus from the diagnosis to risk assessment. From the studies quoted this seems to work worldwide (Johnell et al., 2005).
A WHO project on risk assessment is almost finished and a technical report will soon be published, where risk assessment is based on health economically determined cut offs with absolute fracture risk. There are several clinical risk factors that can be used in risk assessment but they have to be validated in multiple populations, adjusted for age, sex and type of fracture, readily assessable by primary care physicians, contribute to a risk that is amenable to the therapeutic manipulation intended, intuitive rather than counterintuitive to medical care (Kanis et al., 2002b). A cornerstone of the clinical risk factor is a BMD measurement but also other risk factors have to be added to BMD. The predictive ability of BMD + clinical risk factors is much better than clinical risk factors only. If there is a possibility to use BMD worldwide more patients at high risk will be identified by using a BMD measurement. Going without your pills? Buy cheap sale viagra online
