By Salynn Boyles
WebMD Medical News

Reviewed By Louise Chang, MD

Feb. 21, 2008 -- For the first time, the nation's leading osteoporosis group is recommending routine bone density testing for men as well as women.

New guidelines released Thursday by the National Osteoporosis Foundation (NOF) call for bone mineral density (BMD) testing for all men ages 70 and older and for younger men with risk factors for bone loss.

Testing is also recommended for all women ages 65 and older, as well as younger, postmenopausal women with risk factors for osteoporosis.

NOF officials also unveiled a new method for identifying people at high risk for developing osteoporosis and suffering fractures, which they called a major breakthrough for determining who should and should not be treated.

More than half of fractures related to bone loss occur in people who do not yet have osteoporosis but have a borderline condition of low bone mass called osteopenia.

An estimated 10 million Americans have osteoporosis, but three times as many are believed to have osteopenia.

Until now, clinicians have had no clear guidelines for assessing fracture risk in these patients, NOF President Ethel Siris, MD, tells WebMD.

"We haven't really had a good way of determining which osteopenic patients are high risk and should be treated and which are low risk and may not need treatment," she says.

Assessing Fracture Risk

The guideline is based on a new 10-year fracture probability model developed by the World Health Organization (WHO).

The model was developed using risk assessment data from studies largely conducted within the last decade involving some 60,000 people.

"We have learned a lot over the last 10 years about which risk factors are important for determining fracture risk," osteoporosis specialist Robert Lindsay, MD, PhD, said in a Thursday afternoon news conference. Lindsay served on the NOF committee that wrote the new clinician's guide.

Those risk factors include:

• Gender and age
• Suffering a previous fracture
• Being underweight
• Use of oral steroids
• Having a parent who suffered a hip fracture
• Being a smoker
• Drinking alcohol in excess

Other factors such as having rheumatoid arthritis or any autoimmune disease, getting little or no exercise, and not getting enough calcium and vitamin D can also contribute to fracture risk.

The WHO model is designed to determine a person's risk of suffering a fracture within 10 years, based on the results of bone density testing and risk factor assessment.

The new guidelines call for treatment to be offered to anyone with low bone mass and whose 10-year risk for suffering a hip fracture exceeds 3% or whose risk for any fracture related to bone loss exceeds 20%, Siris says.

"That doesn't mean people should not be treated if their risk does not meet this threshold," Siris says. "But it makes it very clear that above this threshold it is medically proper and cost-effective to treat these patients."

Fractures related to osteoporosis and bone loss cost the U.S. health care system an estimated $17 billion in 2005, and this cost is projected to double or even triple over the next 20 to 30 years as the population ages.

Having better ways of identifying patients who would benefit from treatment could save health care dollars by reducing fractures and allowing low-risk patients to avoid unnecessary treatments, Siris says.

Reducing Your Risk

Although men have a lower risk for osteoporosis-related fractures than women, their risk is far from insignificant.

One in five men will experience an osteoporosis-related fracture in his lifetime, compared with one out of two white women, according to the surgeon general.

Recommendations cited in the NOF report to help postmenopausal women and men over 50 reduce their osteoporosis risk include:

• Make sure you get at least 1,200 milligrams per day of calcium and 800 to 1,000 international units of vitamin D.
• Engage in regular weight-bearing and muscle-strengthening exercise to reduce the risk for falls and fractures.
• If you smoke, stop. And if you drink alcohol, don't drink too much.
• Know your osteoporosis risk factors and follow your doctor's advice with regard to testing and treatment.

SOURCES: National Osteoporosis Foundation Clinician's Guidelines to Prevention and Treatment of Osteoporosis. Tosteson, A.N.A. and Dawson-Hughes, B. Osteoporosis International, online edition. Ethel S. Siris, MD, president, National Osteoporosis Foundation. Robert L. Lindsay, MD, PhD, chief, Osteoporosis Center, Helen Hayes Hospital, West Haverstraw, N.Y. Bone Health and Osteoporosis: A Report of the Surgeon General, 2004.

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