Abstract
Osteoporosis is a skeletal disorder in which reductions in bone strength predispose to an increased risk for fractures. Currently, the diagnosis is officially made based exclusively on bone mineral density T-scores that are ≤−2.5 at the spine or hip. Limiting the clinical diagnosis of osteoporosis solely to a T-score-based criterion, which is the official convention in the USA, creates uncertainty about the use of the term osteoporosis to diagnose older women and men who have T-scores >−2.5, but either have already sustained low-trauma fractures or are recognized as having high fracture risk based on absolute fracture risk calculations from FRAX or other algorithms. A failure to diagnose such patients as having osteoporosis may be one component of the well-documented underdiagnosis and undertreatment of this disease which limits our ability to reduce the burden of fractures worldwide. There is a need to expand the criteria for making a clinical diagnosis and to codify these changes in order to help patients, physicians, policy makers, and payers better understand who has this disease and the elevated risk for fracture that it represents.
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Conflicts of interest
Ethel S. Siris is a consultant of Amgen, Benvenue, Eli Lilly, Merck, Pfizer, and Novartis; lecture fees are from Amgen and Eli Lilly. Steven Boonen received research grants from Amgen, Novartis, and Servier; consulting fees are from Amgen, Novartis, and Servier; lecture fees are from Amgen, Novartis, and Servier. Paul J. Mitchell is a consultant of Amgen, GSK, and Daiichi Sanryo. John Bilezikian received grants from NPS and Amgen, and is a consultant of GSK, Lilly, Merck, Amgen, NPS and Warner Chilcott; lecture fees are from Lilly, Amgen, and Novartis. Stuart Silverman received research support from Lilly, Merck, Alliance for Better Bone Health, Roche Genentech Pharmaceuticals, Roche Diagnostics, Novartis, Pfizer, and Medtronics, and is a consultant of Merck, Amgen, Roche Diagnostics, Novartis, Pfizer, and Lilly; he is part of the speaker’s bureau of Lilly, Amgen, Warner Chilcott, Roche Genentech, and Pfizer. Dr. Boonen is senior clinical investigator of the Fund for Scientific Research, Flanders, Belgium (F.W.O.-Vlaanderen) and holder of the Leuven University Chair in Gerontology and Geriatrics. No funding was provided by that source for work on this manuscript.
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Siris, E.S., Boonen, S., Mitchell, P.J. et al. What’s in a name? What constitutes the clinical diagnosis of osteoporosis?. Osteoporos Int 23, 2093–2097 (2012). https://doi.org/10.1007/s00198-012-1991-0
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DOI: https://doi.org/10.1007/s00198-012-1991-0