Paper Finds the Use and Widespread Adoption of NBHA's New Diagnostic Criteria for Osteoporosis Could Help Identify Additional Patient Populations at High Risk for Fracture
WASHINGTON, Jan. 10, 2017 -- A paper recently published online by Osteoporosis International examined the impact the National Bone Health Alliance's expanded criteria for diagnosing osteoporosis would have on the prevalence of the condition in the U.S. The paper's authors concluded that 16% of men and 29.9% of women age 50 or above have osteoporosis based on the NBHA's expanded diagnostic criteria, as compared to 4.3% of men and 15.4% of women age 50 and above who have osteoporosis when the diagnosis is based on bone mineral density (BMD) with a T-score of -2.5 or below alone.
Osteoporosis is a disease in which an individual's bones become weaker and more likely to break after minor trauma. The disease is responsible for an estimated two million broken bones per year, yet the majority of patients who suffer from a fracture are released without being evaluated for osteoporosis – the underlying disease which likely led to the fracture. The U.S. currently spends more than $19 billion to treat fractures and the cost is projected to rise to more than $25 billion by 2025.
"Better identifying people at risk for fracture will help prevent future fractures and is the key to sparing many older Americans from the pain, suffering and reduced quality of life associated with broken bones," said Dr. Ethel Siris, the paper's senior author and chair of the NBHA Clinical Diagnosis Working Group, NBHA Executive Committee member, Madeline C. Stabile Professor of Medicine and Director of the Toni Stabile Osteoporosis Center at Columbia University Medical Center, New York-Presbyterian Hospital. "With the NBHA's expanded clinical diagnosis of osteoporosis, we can appropriately diagnose and treat the older adults facing an increased risk for fracture, which will greatly improve their quality of life and produce an enormous cost savings for the healthcare system."
As detailed in a 2014 position paper published by Osteoporosis International, NBHA's Clinical Diagnosis of Osteoporosis Working Group, made up of 17 clinicians and clinical scientists, recommended expanding the standard criterion for diagnosing osteoporosis among postmenopausal women and men age 50 and older in the U.S. from a T-score of less than or equal to -2.5 at the hip or spine as measured by BMD testing to also allow a diagnosis for individuals who have experienced a hip fracture with or without BMD testing and those who have low bone density determined by BMD who sustain a vertebral, proximal humeral, pelvic, or in some cases, distal forearm fracture.
The expanded criteria also includes diagnosing individuals with an elevated fracture risk based on the World Health Organization Fracture Risk Algorithm (FRAX), which calculates a person's 10-year fracture risk and is recommended to assess risk in people whose BMD test show low bone mass (T-score >−2.5 <−1.0) used in the U.S.
The new diagnostic criteria for osteoporosis recommended by NBHA have been endorsed by 13 national organizations: Alliance for Aging Research; American Association for Clinical Endocrinologists; American Association of Nurse Practitioners; American Academy of Orthopedic Surgeons; American Bone Health; American Society for Bone and Mineral Research; Endocrine Society; International Geriatric Fracture Society; International Society for Clinical Densitometry (U.S.); National Association for Nurse Practitioners in Women’s Health; National Bone Health Alliance; National Osteoporosis Foundation; and Society for Women’s Health Research. However, the impact of the expanded diagnostic criteria on prevalence estimates of those with osteoporosis had not been investigated.
The study's authors set out to estimate the proportion of the U.S. population of postmenopausal women and men age 50 and older who would be identified as having a clinical diagnosis of osteoporosis based on the expanded criteria recommended by the NBHA. The study concluded that the new expanded criteria for the clinical diagnosis of osteoporosis, intended to identify those older men and women at high risk for fracture, increases the prevalence of the condition beyond that found with BMD alone and could help identify and protect additional patients at elevated risk of fracture.
"The widespread adoption and use of NBHA's expanded clinical diagnosis of osteoporosis will help educate the healthcare community on the link between osteoporosis and fractures and ensure those patients who clearly have osteoporosis or have suffered a fracture due to osteoporosis are diagnosed and treated correctly," said Dr. Kenneth Saag, one of the paper's co-authors and NBHA co-chair, member of the NBHA Clinical Diagnosis Working Group and Jane Knight Lowe Professor of Medicine, Division of Clinical Immunology and Rheumatology and Vice Chair, Department of Medicine at the Alabama at Birmingham (UAB) School of Medicine.
"Using these new diagnostic criteria will help clinicians identify those patients at high risk," said Dr. Robert Adler, NBHA co-chair, member of the NBHA Clinical Diagnosis Working Group and Professor of Internal Medicine, Epidemiology and Community Health, Virginia Commonwealth University School of Medicine and Chief, Endocrinology and Metabolism, McGuire Veterans Affairs Medical Center. "This is a significant step toward reducing the nearly 80 percent fracture care gap of older Americans in the U.S. who suffer bone breaks, but are not tested or treated for osteoporosis."
About the National Bone Health Alliance
Established in late 2010, the National Bone Health Alliance is a public-private partnership that brings together the expertise and resources of various partners across a broad spectrum to promote bone health and prevent disease; improve diagnosis and treatment of bone disease; and enhance bone research, surveillance and evaluation. The NBHA is a platform that allows all voices in the bone health community to work together around shared priorities and develop projects that can become reality through pooled funding. The 51 members of the Alliance (in addition to liaisons representing the Centers for Disease Control and Prevention, National Aeronautics and Space Administration, National Institutes of Health and U.S. Food and Drug Administration) are working from a shared vision: to improve the overall health and quality of life of all Americans by enhancing their bone health. For more information on the NBHA, visit www.nbha.org.
David Lee, MPA