New guidelines for testing and treating osteoporosis, from Harvard Women's Health Watch

If you are over age 50, you have a 50-50 chance of breaking a bone at some point because of osteoporosis. Osteoporosis weakens bones, leaving them vulnerable to fracture. In recent years, there's been a subtle but important shift in approaches to reducing risk, from treating low bone mineral density toward preventing fractures, according to the December 2009 issue of Harvard Women's Health Watch.

Years ago, the World Health Organization (WHO) developed criteria for diagnosing osteoporosis based on a measurement of bone mineral density called a T-score. But bone mineral density alone can't predict who's most likely to break a bone. Among postmenopausal women, as many as half of all fractures occur in those whose T-scores don't meet the criteria for full-blown osteoporosis.
In 2008, a WHO task force introduced FRAX (www.shef.ac.uk/FRAX), a new risk assessment tool that incorporates risk factors besides bone mineral density, including age, sex, height, weight, previous fracture, and parental history, among others. FRAX provides an estimate of the likelihood that you will suffer a major fracture in the next 10 years. Using this tool, the National Osteoporosis Foundation has issued new guidelines that are helping to clarify who should be tested and treated.

Several medications are available to help prevent fractures. Harvard Women's Health Watch notes the guidelines suggest that clinicians consider prescribing medication to people ages 50 and over who meet one or more of the following criteria: a past hip or spine fracture, a T-score of less than –2.5 at the hip or spine, or a T-score of –1.0 to –2.5 at the hip or spine together with a 10-year FRAX-estimated risk of more than 20% for any major fracture (or more than 3% for hip fracture).

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