New NOF Osteoporosis Clinic Guide

Risk assessment

all postmenopausal women and older men should be in the clinical assessment of osteoporosis risk, needs to be done to determine whether bone mineral density (BMD) examination. Generally speaking, The more risk factors, the greater the risk of fracture. Osteoporosis is preventable and treatable, but because there is no early warning signs prior to fracture, so many people can not accept the disease early diagnosis and prompt effective treatment. Many factors can increase bone the risk of osteoporosis-related fractures.

Since the majority of osteoporosis-related fractures are caused by falls, so the assessment of risk factors for falls are also important. In addition to muscle weakness, gait, balance and visual defects, The most important seems to be falling personal history.

in the WHO's 10-year fracture risk model, risk factors, the present age, gender, history of fracture, femoral neck BMD, low BMI and whether use of oral glucocorticoids, but also whether the secondary osteoporosis, parents hip fracture history, smoking, drinking large. WHO pointed out that this group of risk factors combined with BMD measurements to assess the patient's fracture risk.

addition to osteoporosis, the metabolic bone diseases (such as a gland next to Kang or osteomalacia) can lower the BMD. Many of these patients have very special effects of the treatment, diagnosis of osteoporosis based solely on BMD history of osteoporosis should be completed before the collection and examination.

If there can be considered the treatment of patients with secondary causes of osteoporosis, should be done before starting treatment, the corresponding blood and urine tests (such as serum calcium, urinary calcium, serum thyrotropin, protein electrophoresis, cortisol, or gluten sensitive enteropathy on antibodies). of recent fractures in elderly patients, secondary causes should be assessed, considering the osteomalacia or vitamin D deficiency should be Serum 25 (OH) D levels. In general, patients diagnosed with osteoporosis should be considered before beginning therapy biochemical tests done (such as serum calcium and creatinine).

diagnostic criteria

osteoporosis diagnosis based on BMD measurements. fractures in a low-invasive high-risk patients can often make a preliminary diagnosis of osteoporosis or clinical diagnosis.

bone mineral density measurement and classification

axial DXA hip and spine are now using dual energy X ray absorptiometry (DXA) to determine or confirm the diagnosis of osteoporosis, predict future fracture risk, and through a series of measurements to monitor patients.

diagnosis according to WHO classification, BMD diagnosis were divided into normal: BMD in the "normal young" adult BMD 1 standard deviation (SD) or less (T min ≥ -1.0); low bone (" osteopenia "): BMD than the" normal young "adults with low BMD 1.0 ~ 2.5 SD (T min -1.0 ~ -2.5); osteoporosis: BMD more than" normal young "adults with low BMD ≥ 2.5 SD (T sub ≤ -2.5); severe osteoporosis or certain: had 1 or more fractures in this group of patients.

in postmenopausal women and ≥ 50-year-old man, WHO for T sub-standard diagnosis (normal, low bone mass and osteoporosis) for axial DXA (lumbar spine, total hip and femoral neck) of the BMD measurements. If you can not measure the hip or spine BMD, a 1 / 3 radius site The DXA BMD measurements to diagnose osteoporosis. in premenopausal women or 50-year-old men and children, do not use the BMD WHO diagnostic classification criteria. In this group of population, not only according to the density measurement standard diagnosis of osteoporosis . International Society of Clinical Densitometry (ISCD) recommendations, not T divided, it should be corrected with a racial or ethnic sub-Z, Z min ≤ -2.0 is defined as the "chronological age than low bone mineral density" or "than the expected age Range Low "; Z points -2.0 is defined as" expected in this age range ".

BMD Check indications

1. age ≥ 65 years for women and ≥ 70 years men, with or without clinical risk factors.

2. have risk factors for younger postmenopausal women and 50 to 70 year-old man.

3. menopausal transition women, if increased risk of a fracture of special risk factors such as low birth weight, a low invasive fracture history or in the use of high-risk drugs.

4.50 after the age of fractures in adults.

5. There lead to low bone mass or bone loss disease (eg rheumatoid arthritis) or lead to low bone mass or bone loss drugs (eg glucocorticoids ≥ 5 mg / d ≥ 3 months) in adults.

6. consider the use of osteoporosis drugs of any person.

7. is the treatment of osteoporosis with any person, to monitor treatment effect.

8. There are no treatment, but there is evidence of bone loss, the treatment of people.

9. deactivate estrogen in postmenopausal women should consider doing BMD examination.

prevention

1. recommended that all patients adequate intake of calcium and vitamin D.

2. Recommended for women over 50 years of age to at least 1200 mg elemental calcium intake. 1200 ~ 1500 mg intake / d may be limited benefits and may increase the incidence of kidney stones or cardiovascular disease risk. NOF recommended daily intake for adults 50 years old 800 ~ 1000 international units (IU) of vitamin D3. This will make adults mean serum 25 ( OH) D concentration rose to the desired level ≥ 30 ng / ml (75 nmol / L).