In February 2008, the National Osteoporosis Foundation (NOF) released its new “Clinician’s Guide to Prevention and Treatment of Osteoporosis.” The guide has been expanded to include men age 50 and older, as well as African-American, Asian and Latina postmenopausal women. These new guidelines encourage men age 70 and older to get routine bone mineral density checks.
“NOF’s new Clinician’s Guide dramatically alters the approach to assessing fracture risk and treatment,” says Bess Dawson-Hughes, MD, chair of the Clinician’s Guide Development Committee and past president of NOF. “The Guide provides evidence-based recommendations to help healthcare providers better identify people at high risk for developing osteoporosis and fractures, and assures that those at highest risk are recommended for treatment to lower that risk.”
The new guide applies the World Health Organization’s algorithm on absolute fracture risk, called FRAX®. This algorithm estimates the likelihood of a person breaking a bone due to low bone mass or osteoporosis during a period of 10 years. The factors used to calculate this risk are the bone mineral density at the hip, and nine clinical risk factors for osteoporosis and related fractures.
“We’ve been screening for a few years for bone loss because some of our patients had fractures and we were concerned HIV medications may cause loss of bone,” says Rosemary Cook, MD, HIV specialist, General Internal Medicine at Penn Comprehensive Hemophilia Program in Philadelphia. “From our standpoint, having formal recommendations is great.”
The recommendations are a positive step, says Cook, particularly for some of her male patients with hemophilia who contracted HIV/AIDS in the 1980s. “Low testosterone levels are something we’ve seen in HIV—whether it’s the drugs or the HIV, we don’t know—but it’s something that can certainly lead to bone loss.”
According to NOF, more than half of fractures from bone loss occur in people with osteopenia, a thinning of the bones not extensive enough to be considered osteoporosis. In addition to routine bone mineral density checks for older men, the guidelines recommend:
- Treating postmenopausal women and men 50 and older who have thinning bones, but not yet osteoporosis, if they have at least a 20% risk of any major fracture in the next 10 years or at least a 3% risk of a hip fracture.
- Checking for osteoporosis risk factors in postmenopausal women and men age 50 and older to determine who needs a bone test before age 70.
- Conducting a bone test on anyone who has a fracture after age 50 or has conditions associated with bone loss, such as HIV/AIDS.
- Engaging in regular weight-bearing and strengthening exercises.
The guide recommends that all adults age 50 and older consume 1,200 mg of calcium and 800–1000 IU of vitamin D3 daily.