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The impact of fragility fractures and approaches to osteoporosis risk assessment worldwide

The impact of fragility fractures and approaches to osteoporosis risk assessment worldwide
The impact of fragility fractures and approaches to osteoporosis risk assessment worldwide
Osteoporosis constitutes a major public health problem, through its association with age-related fractures, particularly of the hip, vertebrae, distal forearm and humerus. Substantial geographic variation has been noted in the incidence of osteoporotic fractures worldwide, with Western populations (North America, Europe and Oceania), reporting increases in hip fracture throughout the second half of the 20th century, with a stabilisation or decline in the last two decades. In developing populations however, particularly in Asia, the rates of osteoporotic fracture appears to be increasing. The massive global burden consequent to osteoporosis means that fracture risk assessment should be a high priority among health measures considered by policy makers.

The WHO operational definition of osteoporosis, based on a measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), has been used globally since the mid-1990s. However, although this definition identifies those at greatest individual risk of fracture, in the population overall a greater total number of fractures occur in individuals with BMD values above threshold for osteoporosis diagnosis. A number of web-based tools to enable the inclusion of clinical risk factors, with or without BMD, in fracture prediction algorithms have been developed to improve the identification of individuals at high fracture risk, the most commonly used globally being FRAX®. Access to DXA, osteoporosis risk assessment, case finding and treatment varies worldwide, but despite such advances studies indicate that a minority of men and women at high fracture risk receive treatment. Importantly, research is ongoing to demonstrate the clinical efficacy and cost-effectiveness of osteoporosis case finding and risk assessment strategies worldwide. The huge burden caused by osteoporosis related fractures to individuals, healthcare systems and societies should provide a clear impetus for the progression of such approaches.
8756-3282
1-27
Curtis, Elizabeth
12aba0c3-1e9e-49ef-a7e9-3247e649cdd6
Moon, Rebecca
954fb3ed-9934-4649-886d-f65944985a6b
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Curtis, Elizabeth
12aba0c3-1e9e-49ef-a7e9-3247e649cdd6
Moon, Rebecca
954fb3ed-9934-4649-886d-f65944985a6b
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6

Curtis, Elizabeth, Moon, Rebecca, Harvey, Nicholas and Cooper, Cyrus (2017) The impact of fragility fractures and approaches to osteoporosis risk assessment worldwide. Bone, 1-27. (doi:10.1016/j.bone.2017.01.024).

Record type: Article

Abstract

Osteoporosis constitutes a major public health problem, through its association with age-related fractures, particularly of the hip, vertebrae, distal forearm and humerus. Substantial geographic variation has been noted in the incidence of osteoporotic fractures worldwide, with Western populations (North America, Europe and Oceania), reporting increases in hip fracture throughout the second half of the 20th century, with a stabilisation or decline in the last two decades. In developing populations however, particularly in Asia, the rates of osteoporotic fracture appears to be increasing. The massive global burden consequent to osteoporosis means that fracture risk assessment should be a high priority among health measures considered by policy makers.

The WHO operational definition of osteoporosis, based on a measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), has been used globally since the mid-1990s. However, although this definition identifies those at greatest individual risk of fracture, in the population overall a greater total number of fractures occur in individuals with BMD values above threshold for osteoporosis diagnosis. A number of web-based tools to enable the inclusion of clinical risk factors, with or without BMD, in fracture prediction algorithms have been developed to improve the identification of individuals at high fracture risk, the most commonly used globally being FRAX®. Access to DXA, osteoporosis risk assessment, case finding and treatment varies worldwide, but despite such advances studies indicate that a minority of men and women at high fracture risk receive treatment. Importantly, research is ongoing to demonstrate the clinical efficacy and cost-effectiveness of osteoporosis case finding and risk assessment strategies worldwide. The huge burden caused by osteoporosis related fractures to individuals, healthcare systems and societies should provide a clear impetus for the progression of such approaches.

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FINAL Approaches to risk assessment and the geography of high fracture probability 13-01-17.docx - Accepted Manuscript
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Accepted/In Press date: 20 January 2017
e-pub ahead of print date: 22 January 2017
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 405062
URI: http://eprints.soton.ac.uk/id/eprint/405062
ISSN: 8756-3282
PURE UUID: 9f0270fe-2e53-439a-9fbd-85856bc485ae
ORCID for Elizabeth Curtis: ORCID iD orcid.org/0000-0002-5147-0550
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 26 Jan 2017 14:19
Last modified: 07 Oct 2020 04:57

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Author: Rebecca Moon
Author: Nicholas Harvey ORCID iD
Author: Cyrus Cooper ORCID iD

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