It is time to broaden the definition of osteoporosis used in clinical guidelines, states an article published in Age and Ageing, the official journal of the British Geriatrics Society.
The authors recommend that the World Health Organization (WHO) and the International Society for Clinical Densitometry to consider a broader definition of osteoporosis which encompasses clinical diagnosis, providing clear guidance on communicating bone mineral density (BMD) results to patients.
The WHO definition of osteoporosis, which is endorsed as a diagnostic threshold in current UK and European guidance, still relies purely on BMD testing (T-score of −2.5 SD or more). The authors say this definition no longer relates to the population for whom osteoporosis drugs are recommended.
In the past 15 years, they say, there has been a change in the field of osteoporosis, namely to base osteoporosis management not just on absolute values of BMD but on broader consideration of future fracture risk. This change has been underpinned by observations that the majority of patients with a fragility fracture do not have osteoporotic BMD.
Co-author Dr Zoe Paskins, a Senior Lecturer at Keele University and Clinical Lead for the osteoporosis service in North Staffordshire, argues that many people with osteoporosis do not receive the treatment they need due to inconsistencies with how the condition is diagnosed around the world, resulting in confusion for both clinicians and patients.
“We think it is time for the WHO to reconsider the definition of osteoporosis, which is now more than 25 years old. A new definition is needed to acknowledge that it is possible, in some circumstances, to give a clinical diagnosis of osteoporosis in those who have osteoporotic fractures. In our view this would help address current confusion and improve uptake of treatments,” she says.