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Greater Osteoporosis Testing and Education Needed

More women should be getting tested for osteoporosis, a devastating bone disease that can lead to debilitating fractures, according to results from the largest U.S. study of osteoporosis risk factors.

The study of more than 200,000 women from 34 states found that almost half of women over age 50 who visit primary care doctors in the United States are at some risk for osteoporosis. The women had been patients of more than 4,000 primary care doctors between Fall 1997 and Spring 1999. To be included in the National Osteoporosis Risk Assessment, women had to be more than 50 years old, menopausal, and not previously diagnosed with osteoporosis. The researchers measured the bone mineral density of the forearm, finger, or heel of each woman in the study using a Food and Drug Administration-approved device. The physicians who participated in the research did so to learn more about the frequency and risk factors of osteoporosis to better treat patients in their practices.

"Physicians 20 years ago would say osteoporosis was an inevitable part of aging for women," Dr. Siris explains. "It has been only 10 years since there have been greater awareness of and more therapies for osteoporosis. It is taking time for the message to reach all doctors." To prevent bone loss associated with osteoporosis, women should have enough calcium and vitamin D in their diets, stop smoking, and engage in physical exercise, Dr. Siris says. A variety of medications also are available to prevent and treat osteoporosis.

The investigators collected an enormous amount of health information from the women, such as medication and hormone use, alcohol consumption, smoking status, fracture history, and mother's history of osteoporosis. They also asked the women to answer a questionnaire about fractures and other medical issues one year after their initial evaluation.

The researchers found that risk factors for osteoporosis for the women in the study were increasing age, a personal or family history of fracture, Asian or Hispanic heritage, smoking, and the use of glucocorticoids, any of a group of steroid hormones from the adrenal gland that are used to treat a variety of medical conditions. High body mass index, African American heritage, estrogen or diuretic use, exercise, and alcohol consumption decreased the likelihood of osteoporosis among the women in the study. Body mass index is a measure of weight to height and is associated with body fat and health risk. From the bone density measurement, the investigators characterized the women as being normal or having either osteoporosis or osteopenia, a precursor condition to osteoporosis. They found that 39.6 percent of the 200,160 women in the study had osteopenia and 7.2 percent had osteoporosis, which translates to nearly 50 percent having some risk for osteoporosis.

Although the gold standard to measure bone mineral density is dual X-ray absorptiometry (DXA) of the hip and spine, or the central skeleton, the study found that measurements of bone mineral density at peripheral sites (such as the forearm, finger and heel) can predict future fracture risk. Among the 163,979 participants who underwent peripheral measurement and provided one year of follow-up information, osteoporosis was associated with a fracture rate four times that expected in normal women; osteopenia had fracture rate nearly twice that of normals. Fractures of the hip, wrist, rib, and spine were included in the rate.

MEDICA.de; Source: Columbia University

 
 
 

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