Osteoporosis case ascertainment strategies in European and Asian countries: a comparative review

Abstract

While many clinical guidelines recommend screening for osteoporosis for early detection and treatment, there is great diversity in the case-finding strategies globally. We sought to compare case-finding strategies, focusing on the approaches used in European and Asian countries. This article provides an overview of the current case-finding strategies in the UK, Germany (including Austria and German-speaking regions of Switzerland), China, Japan, and Korea. We conducted a review of current treatment guidelines in each country and included expert opinions from key opinion leaders. Most countries define osteoporosis among patients with a radiographically identified fracture of the hip or the vertebrae. However, for other types of fractures, or in the absence of a fracture, varying combinations of risk-factor assessment and areal bone mineral density (aBMD) assessed by dual X-ray absorptiometry are used to define osteoporosis cases. A T-score ≤ − 2.5 is accepted to identify osteoporosis in the absence of a fracture; however, not all countries accept DXA alone as the sole criteria. Additionally, the critera for requiring clinical risk factors in addition to aBMD differ across countries. In most Asian countries, aBMD scanning is only provided beyond a particular age threshold. However, all guidelines recommend fracture risk assessment in younger ages if risk factors are present. Our review identified that strategies for case-finding differ regionally, particularly among patients without a fracture. More homogenized ways of identifying osteoporosis cases are needed, in both the Eastern and the Western countries, to improve osteoporosis case-finding before a fracture occurs. Case-finding in osteoporosis is essential to initiate treatment and minimize fracture risk. We identified differences in case-finding strategies between Eastern and Western countries. In the absence of a diagnosed fracture, varying combinations of risk factors and bone density measurements are used. Standardized case-finding strategies may help improve treatment rates.

Assessment of the use of different risk algorithms for osteoporotic fractures in women in the practice of a family doctor

“…Low sensitivity was the main reason not to recommend BMD testing for population screening [14]. Fracture risk assessment is improved by simultaneously considering risk factors that operate independently of BMD [19]. A survey was carried out on a small group of women.…”

Long-Term Treatment of Postmenopausal Osteoporosis

“…Most osteoporosis guidelines, including the Korean Society for Bone and Mineral Research (KSBMR) recommend treatment for women at high risk of fracture, using fixed intervention thresholds, defined as: (1) postmenopausal women (age 50 and older) with a prior major osteoporotic fracture (MOF; hip, clinical vertebral, humerus, forearm) without the requirement of an osteoporotic BMD (lumbar spine or hip T-score ≤−2.5); (2) women ≥65 years or younger with risk factors and an osteoporotic BMD [ 17 ]. Under this guideline, patients receive coverage for medical treatment costs over a period of 3 years [ 17 ].…”

The mechanism of Epimedin B in treating osteoporosis as revealed by RNA sequencing‐based analysis

“…Osteoporosis is a systemic skeletal disease characterized by loss of bone mass and bone microstructure integrity, which ultimately results in bone fragility and a higher risk of fractures. 1 Patients with severe osteoporosis are prone to undergo pathological fractures even during daily activities or minor trauma. After osteoporotic fractures, up to half of the patients develop into permanent disabilities, and 20% of them even died due to complications within 1 year.…”