Predicting Breaks From Seniors' Thinning Bones _ Don't Forget the Men
Monday, February 25, 2008        14:31 EST

Washington, D.C.  --  Bone tests aren't just for women anymore. New
guidelines are calling for older men to get a routine check for
bone-thinning osteoporosis.

There's news for women, too: A new computerized tool uses more than
bone-density tests to predict who is at highest risk of breaking a bone
in coming years _ by adding in such important risk factors as whether a
parent ever broke a hip.

It's an effort to better target who really needs treatment and who can
safely skip it, even before someone's bones become thin enough to be
officially labeled an osteoporosis patient.

And it promises a major shift in bone care.

"You treat the people who have high risk, and you would reassure the
women at low risk and ask them to come back for a re-check in a few
years," explains Dr. Ethel Siris of Columbia University and president of
the National Osteoporosis Foundation, which issued the new guidelines
last week.

Moreover, the new work stresses that a disease long associated with
little old white ladies actually can strike anyone as they age. The
biggest change: The NOF guidelines recommend a bone-mineral density
X-ray test for all men 70 and older, just like women 65 and older have
long been urged to get. (Men and women may need the tests sooner if
other factors put them at high risk.)

"There's a recognition more so now than in the past that men are at
risk," says Dr. Jay Magaziner of the University of Maryland medical
school, who has long researched hip fractures _ osteoporosis'
most-feared break.

Don't misunderstand. Postmenopausal women are still at greatest risk of
osteoporosis, when bone-strengthening estrogen plummets. But a quarter
of hip fractures occur in men, and as men live longer, the number who
break a hip is steadily rising, Magaziner told a recent meeting of the
American Academy of Orthopaedic Surgeons.

Screening men "as we do with women can have some real payoffs in terms
of prevention," he says.

Another conundrum: More than half of fractures due to bone loss occur in
people whose bones are thinning but aren't quite thin enough to be
labeled osteoporosis. They're in a gray zone known as osteopenia.

In the U.S. alone, some 10 million people have osteoporosis but 34
million are estimated to have osteopenia. With the population rapidly
aging, the government estimates half of Americans over 50 will be at
risk of fractures from too-thin bones by 2020.

The World Health Organization funded a Web-based tool called FRAX,
unveiled last week, that helps calculate the odds of a hip, wrist,
shoulder or spine fracture within the next 10 years for anyone 40 or
older in nine different countries _ regardless of whether they have
full-fledged osteoporosis or just low bone mass.

Both geography and ancestry matter for bone health. Consider differences
such as diet, exercise and exposure to Vitamin D-making sunlight, and
odds of a break differ dramatically from China and Japan, to France and
Spain, and on to the highest-risk U.S. and Sweden. Here, white women
have the highest risk and black women the lowest. FRAX lets users take
all that into account.

How? Researchers at Britain's University of Sheffield used data from
60,000 people in developed countries _ where life expectancy is long
enough for osteoporosis to be an issue _ to determine factors that play
the biggest role in an individual's odds of thinning bones as they age.

Breaking a bone during adulthood that's not the result of, say, a bad
car crash is one risk factor. A parent who broke a hip suggests a
genetic risk. Smoking also thins bones, as does heavy alcohol
consumption and long-term use of steroid-containing medicines.

Plug in a patient's score from a bone-density measurement of the hip for
the final calculation.

That number alone doesn't say whether someone needs bone-building
treatment. So in the U.S., the National Osteoporosis Foundation went a
step further. It used the FRAX predictions to update guidelines on who
needs bone-density testing, and to calculate when fracture risk becomes
high enough that bone-building drugs would be cost-effective.

In addition to a routine bone check for older men, the guidelines recommend:

_Treat postmenopausal women and men 50 and older who have thinning
bones, but not osteoporosis yet, if they have at least a 20 percent risk
of any major fracture in the next decade, or at least a 3 percent risk
of a hip fracture.

_Check for osteoporosis risk factors in postmenopausal women and men 50
and over, to see who needs a bone test before their senior years.

_A bone test for anyone who has any type of fracture after age 50, or
who has conditions associated with bone loss, such as rheumatoid arthritis.

_For adults over 50, 1,200 milligrams a day of calcium and 800 to 1,000
international units a day of Vitamin D, more D than the government
recommends.

_Do regular weight-bearing and muscle-strengthening exercise.

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On the Net:

FRAX Web site: http://www.shef.ac.uk/FRAX

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