Identification of Osteopenic Women at High Risk of Fracture: The OFELY Study

Sornay‐Rendu, Elisabeth; Munoz, F.; Garnero, Patrick; Duboeuf, F.; Delmas, Pierre D.

doi:10.1359/jbmr.050609

Cited by 342 publications

(198 citation statements)

References 43 publications

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“…Epidemiological studies have demonstrated that a significant number of individuals with incident osteoporotic fractures have BMD values above the WHO diagnostic threshold of osteoporosis (T-score≥−2.5) [9][10][11][12]. Findings of a recent study indicate that at any given BMD T-score, the risk of incident vertebral, non-vertebral, and any fracture depended heavily on prevalent radiographic vertebral fracture status.…”

Section: Discussionmentioning

confidence: 99%

Spine radiographs to improve the identification of women at high risk for fractures

et al. 2008

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Summary In women older than 60 years with clinical risk factors for osteoporosis but without osteoporosis based on bone mineral density (T-score≥−2.5), a systematic survey with X-rays of the spine identified previously unknown vertebral deformities in 21% of women. Introduction This study determines the prevalence of vertebral deformities in elderly women with clinical risk factors for osteoporosis but with BMD values above the threshold for osteoporosis (T-score≥−2.5). Methods Bisphosphonate naïve women older than 60 years attending 35 general practices in the Netherlands with ≥2 clinical risk factors for osteoporosis were invited for BMD measurement (DXA). In women with T-score≥−2.5 at both spine and the hips, lateral radiographs of the thoracic and lumbar spine were performed. Results Of 631 women with a DXA measurement, 187 (30%) had osteoporosis (T-score < −2.5 at the spine or the hip). Of the remaining 444 women with T-score ≥−2.5 at both spine and hip, 387 had additional spine radiographs, of whom 80 (21%) had at least one vertebral deformity. Conclusion In elderly women with clinical risk factors for osteoporosis but BMD T-score ≥ −2.5, addition of spine radiographs identified vertebral deformities in 21% (95% CI: 17-25). Since these women are at risk of future fractures, antiosteoporotic treatment should be considered.Osteoporos Int

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Section: Discussionmentioning

confidence: 99%

Spine radiographs to improve the identification of women at high risk for fractures

et al. 2008

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“…Although patients with lower BMD are at high risk of fractures, studies have shown that the largest number of osteoporotic fractures occurred among those with osteopenia (BMD -1 to -2.5) 3637. This can be explained by the presence of larger number of subjects with osteopenia than with osteoporosis and therefore even with a lower risk for fractures, the number of fractures can be substantial.…”

Section: Osteopenia and Fracturesmentioning

confidence: 99%

Updated Recommendations for the Diagnosis and Management of Osteoporosis: A Local Perspective

Raef

Al-Bugami

Balharith

et al. 2011

Annals of Saudi Medicine

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Postmenopausal osteoporosis and osteoporosis in elderly men are major health problems, with a significant medical and economic burden. Although osteopenia and osteoporosis are more common locally than in the West, fracture rates are generally less than in Western countries. Vitamin D deficiency is common in the region and contributes adversely to bone health. Vitamin D deficiency should be suspected and treated in all subjects with ostopenia or osteoporosis. The use of risk factors to determine fracture risk has been adopted by the World Health Organization and many international societies. Absolute fracture risk methodology improves the use of resources by targeting subjects at higher risk of fractures for screening and management. The King Faisal Specialist Hospital Osteoporosis Working Group recommends screening for women 65 years and older and for men 70 years and older. Younger subjects with clinical risk factors and persons with clinical evidence of osteoporosis or diseases leading to osteoporosis should also be screened. These guidelines provide recommendations for treatment for postmenopausal women and men older than 50 years presenting with osteoporotic fractures for persons having osteoporosis—after excluding secondary causes—or for persons having low bone mass and a high risk for fracture. The Working Group has suggested an algorithm to use at King Faisal Specialist Hospital that is based on the availability, cost, and level of evidence of various therapeutic modalities. Adequate calcium and vitamin D supplement are recommended for all. Weekly alendronate (in the absence of contraindications) is recommended as first-line therapy. Alternatives to alendronate are raloxifene or strontium ranelate. Second-line therapies are zoledronic acid intravenously once yearly, when oral therapy is not feasible or complicated by side effects, or teriparatide in established osteoporosis with fractures.

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“…Research aimed at establishing composite algorithms that include several risk determinants for the prediction of future fractures is under way (Cummings et al 1995, De Laet et al 1998, Sornay-Rendu et al 2005) but as far as we know, the contribution of multiple fractures as opposed to single fractures has not been considered to date.…”

Section: Fracture Prediction: Relative and Combined Contributions Fromentioning

confidence: 99%

Women with low-energy fracture should be investigated for osteoporosis

et al. 2007

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Introduction Treatment of osteoporosis is becoming more effective, but methods to identify patients who are most suitable for investigation and treatment are still being debated. Should any type of fracture have higher priority for investigation of osteoporosis than any other? Is the number of previous fractures useful information?Material and methods We investigated 303 consecutive women patients between 55 and 75 years of age who had a newly diagnosed low-energy fracture. They answered a questionnaire on previous fractures which also dealt with risk factors. Bone mineral density (BMD) was measured at the hip, lumbar spine, and forearm.Results The distribution of fracture location was: distal forearm 56%, proximal humerus 12%, vertebra 18%, and hip 13%, all with similar age. Half of the subjects had had at least one previous fracture before the index fracture, 19% had had two previous fractures, and 6% had had three or more previous fractures. Patients with vertebral or hip fracture had lower BMD and had had more previous fractures than patients with forearm or humerus fractures. There was an inverse correlation between number of fractures and BMD. Osteoporosis was present in one-third of patients with forearm fracture, in one-half of those with hip or humerus fracture, and in two-thirds of those with vertebral fracture.Interpretation Vertebral fractures were the strongest marker of low BMD and forearm fractures the weakest. The number of previous fractures is helpful information for finding the most osteoporotic patient in terms of severity. Investigation of osteoporosis therefore seems

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Identification of Osteopenic Women at High Risk of Fracture: The OFELY Study

Cited by 342 publications

References 43 publications

Spine radiographs to improve the identification of women at high risk for fractures

Spine radiographs to improve the identification of women at high risk for fractures

Updated Recommendations for the Diagnosis and Management of Osteoporosis: A Local Perspective

Women with low-energy fracture should be investigated for osteoporosis

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