ASSESSMENT OF OSTEOPOROSIS AT THE PRIMARY …

1 report of a WHO Scientific Group ASSESSMENT OF OSTEOPOROSIS AT THE PRIMARY health CARE LEVELJohn A Kanis on behalf of the world health Organization Scientific Group*Organized by the world health Organization Collaborating Centre for Metabolic Bone Diseases,University of Sheffield Medical School, UK and the world health OrganizationReferenceKanis JA on behalf of the world health Organization Scientific Group (2007) ASSESSMENT of OSTEOPOROSIS at the PRIMARY health -care level. Technical health Organization Collaborating Centre for Metabolic Bone Diseases,University of Sheffield, UK. 2007: Printed by the University of to summaryWorld health Organization (2007) ASSESSMENT of OSTEOPOROSIS at the PRIMARY healthcare level.

2 Summary report of a WHO Scientific Group. WHO, Geneva, world health Organization Collaborating Centre for Metabolic Bone Diseases,University of Sheffield Medical School, UKWHO Scientific Group Technical ReportMembers, observers and secretariatProf Philippe BonjourHopital Cantonal Universitaire de GeneveGeneva, SwitzerlandProf Juliet CompstonUniversity of Cambridge Clinical SchoolCambridge, UKProf Bess Dawson-HughesTufts UniversityBoston, USAProf Pierre DelmasHopital Edouard HerriotLyon, FranceMs Helena JohanssonWHO Collaborating Centre for Metabolic BoneDiseasesSheffield, UKProf John A Kanis (Chairman)WHO Collaborating Centre for Metabolic BoneDiseasesSheffield, UKProf Edith LauLek Yuen health CentreHong Kong, ChinaDr Robert LindsayHelen Hayes Hospital, Rt 9WW Haverstraw, NY, USAProf L Joseph Melton III (Rapporteur)Mayo ClinicRochester, USADr Michael R McClungOregon OSTEOPOROSIS CenterPortland, USADr Anders OdenWHO Collaborating Centre for Metabolic BoneDiseases, Sheffield, UKDr Bruce PflegerChronic Respiratory Diseases & Arthritis (CRA)

3 world health Organisation, USAMr Ger TeilenTask Force Audern ArbeidDen Haag, The NetherlandsDr Patricia ClarkHospital de Especialidades Bernardo SepulvedaMexico City, MexicoProf Cyrus CooperSouthampton General HospitalSouthampton, UKDr Chris De LaetInstitute for Public health Brussels, BelgiumProf Claus Gl erKlinikum fur Radiologische DiagnostikKiel, GermanyProf Olof Johnell (Rapporteur)Malmo General HospitalMalmo, SwedenDr Nikolai KhaltaevChronic Respiratory Diseases & Arthritis (CRA), world health OrganisationGeneva, SwitzerlandDr Mike LewieckiNew Mexico Clinical Research & OsteoporosisCenter, IncAlbuquerque, USAProf Paul T LipsVrije UniversityAmsterdam, The NetherlandsDr Eugene V McCloskeyWHO Collaborating Centre for Metabolic BoneDiseases, Sheffield, UKProf Paul D MillerColorado Center for Bone ResearchColorado, USAProf Socrates E PapapoulosLeiden University Medical Center Leiden, The NetherlandsProf Stuart SilvermanDavid Geffen School of Medicine UCLAB everly Hills, USADr Natalia ToroptsovaInstitute of Rheumatology of RAMSM oscow, Russian Federation*WHO Scientific Group onAssessment of OSTEOPOROSIS at the PRIMARY health Care LevelNOTE.

4 THIS PAGE IS THE INSIDE BACK COVER1 report of a WHO Scientific Group ASSESSMENT OF OSTEOPOROSIS AT THE PRIMARY health CARE LEVELJohn A Kanis on behalf of the world health Organization Scientific Group*Organized by the world health Organization Collaborating Centre for Metabolic Bone Diseases,University of Sheffield Medical School, UK and the world health OrganizationWHO Scientific Group Technical Report2 ReferenceKanis JA on behalf of the world health Organization Scientific Group (2007) ASSESSMENT of OSTEOPOROSIS at the PRIMARY health -care level. Technical health Organization Collaborating Centre for Metabolic Bone Diseases,University of Sheffield, UK. 2007: Printed by the University of to summaryWorld health Organization (2007) ASSESSMENT of OSTEOPOROSIS at the PRIMARY healthcare level.

5 Summary report of a WHO Scientific Group. WHO, Geneva, world health Organization Collaborating Centre for Metabolic Bone Diseases,University of Sheffield Medical School, for the of of osteoporotic of from osteoporotic due to osteoporotic burden of of bone mineral and diagnosis of of characteristics of bone mineral of of of clinical risk factors for factors related to impaired bone factors related to excessive bone of clinical risk factors for fracture of risk factors for case of of risk of risk factors126 References1316. Combining risk factors for risk relative of probability of tools for case of of fracture ASSESSMENT tool (FRAX ) validation205 References2088.

6 Intervention of of intervention thresholds in the socio-economic patient-based for case finding233 References2349. ASSESSMENT and therapeutic finding without measurement of measurement of bone mineral finding with measurement of bone mineral Selective use of measurement of bone mineral density with clinical risk implications for dual energy X-ray of ASSESSMENT guidance271 References27610. Summary and conclusions, recommendations for of mineral measurements and diagnosis of risk factors for tools for case and the formulation of therapeutic for research286 Acknowledgements286 Annex 1 Ten-year probabilities of hip fracture (%) in the UK according to age, sex and gradient of risk288 Available at 2 Ten-year probabilities of hip fracture (%) in the UK population according to age, sex and risk ratio295 Available at 3 Ten-year probability of osteoporotic fracture (%) according to BMD, the number of clinical risk factors (CRF) and at 4 Ten-year probability of fracture (%)

7 According to BMI, the number of clinical risk factors and at 5 Relationship between probability and hazard functions. 338 Available at IntroductionA WHO Scientific Group on the ASSESSMENT of OSTEOPOROSIS at the PrimaryHealth Care Level met in Brussels from 5 to 7 May 2004. The meeting wasopened by Dr N. Khaltaev, Responsible Officer for Chronic RespiratoryDiseases and Arthritis, who welcomed the participants on behalf of theDirector-General of the world health Organization (WHO). the publication of the report of a WHO Study Group meeting onAssessment of fracture risk and its application to screening for postmenopausalosteoporosis, OSTEOPOROSIS has been recognized as an established and well-defined disease that affects more than 75 million people in the United States,Europe and Japan (1).

8 OSTEOPOROSIS causes more than million fracturesannually worldwide, of which more than million occur in the Americasand Europe (Table ). The lifetime risk for a wrist, hip or vertebral fracturehas been estimated to be in the order of 30% to 40% in developed countries in other words, very close to that for coronary heart disease. Osteoporosisis not only a major cause of fractures, it also ranks high among diseases thatcause people to become bedridden with serious complications. Thesecomplications may be life-threatening in elderly people. In the Americas andEurope osteoporotic fractures account for million disability-adjusted lifeyears (DALYs) annually, somewhat more than accounted for by hypertensionand rheumatoid arthritis (2), but less than diabetes mellitus or chronicobstructive pulmonary diseases (Fig.)

9 Collectively, osteoporotic fracturesaccount for approximately 1% ofthe DALYs attributable tononcommunicable of diseases estimated as disability-adjusted life years (DALYs) in 2002 in theAmericas and Europe combinedSource: reference 2 (data extracted from Annex Table 3, pp. 126-131) and WHO unpublished number of osteoporotic fractures by site, in men and women aged 50 years ormore in 2000, by WHO region Expected number of fractures All osteoporotic by site (thousands)fracturesProximalWHO Asia2212531213061 Pacifica4324051974642 6721 4167061 6608 959100 Source: O Johnell & J A Kanis, unpublished data, Australia, China, Japan, New Zealand and the Republic of of the morbid consequences of OSTEOPOROSIS , the prevention of thisdisease and its associated fractures is considered essential to the maintenanceof health , quality of life, and independence in the elderly population.

10 In May1998, the Fifty-first world health Assembly, having considered The worldhealth report 1997: conquering suffering, enriching humanity (3), whichdescribed the high rates of mortality, morbidity and disability from majornoncommunicable diseases including OSTEOPOROSIS , adopted a resolutionrequesting the Director-General to formulate a global strategy for theprevention and control of noncommunicable diseases (4). A scientific groupmeeting subsequently reported on the prevention and management ofosteoporosis(5). The report of the present Scientific Group on Assessmentof OSTEOPOROSIS at the PRIMARY health Care Level is a further step in thedevelopment of cohesive strategies for tackling OSTEOPOROSIS in response tothe world health Assembly resolution (4).