What is our duty: Diagnosis of osteoporosis or fracture risk? If we focus on the traditional, although the changing approach to osteoporosis, and perhaps we'd better focus on the diagnosis and treatment / prevention of first or subsequent fractures? To answer this question the doctor must choose between two alternatives. The first option means of diagnosis of diseases according to the official definition. Select another requires risk of fractures, regardless of the cause of destruction, and therefore not only related to osteoporosis fractures. Each element of any variant is characterized by a certain relativism allows you to choose (and support) any of them (for example,) and for diagnosis and treatment. However, the only member of osteoporosis invariably used. What is osteoporosis? Bone and bones, osteoporosis, porous condition, because osteoporosis is a bone thinning / loss of bone density. 65 years ago Albright accurately described it as too little bone to bone. It would seem that the natural process of aging bone. All fabrics are secular changes. They are shown in gray hair, fragile blood vessels, sagging skin and flabby muscles, reducing the effectiveness of the senses, and musculoskeletal poor skills in dealing with everyday obstacles that make patients more susceptible to falling. The volume of bone, its mass and strength decline, its amount and quality suffers, and the risk of fractures increases. Thus, the average absolute 10-year risk of hip fracture in European women do not exceed 0.5% in the 6th decade of life, 1.6% in the 7th decade, 5.3% in the 8 th decade, and above the age '80 value reaches 12.3% (1). These figures refer to total population includes all bone and bone aspects, based on prospective studies and known as the population risk. In the age group 60-69 one out of every 62 women will suffer from hip fractures. In the next decade one woman in 18 (5.3%) and over the age of 80 every eight women. Since the number of 80 or more year old woman several times lower than the 60 and 70-year, the number of fractures at the highest level among young people and more numerous population. (2)
increase the frequency of fractures. At this stage the question of compliance is considered osteoporosis should recognize the state or a sign of aging bones? As in every case >> << The intensity of the process depends on the epidemiological identified factors such as genetic predisposition, lifestyle and nutrition, and other related conditions or medications that have adverse effects on bone tissue. In 1994 WHO standards Osteoporosis defined it as a condition characterized by reduced bone mass and bone microarchitecture violation. (3) To meet the criteria for designation, we must know the exact line between healthy and diseased bone. It was common practice to set rules on ABOUT considered lower than 2 standard deviations, as abnormally low. Later changes divided T-scores (curve falling bone mass with age) in normal, osteopenia and osteoporosis. Further practice, T-score of 2. 5 was the threshold for diagnosing osteoporosis. In this sense, the line between healthy and suffer from osteoporosis based on test results ABOUT only. The implications of this separation means that the person with the right or osteopenia ABOUT denied medical care. However, research in fracture epidemiology in the last few years, compared to low-energy fractures of the defense, showed that between 55% and 75% of these fractures affect people with ON between normal and osteopenia (4,5,6), with T -due to 1. 5. That person who, by the WHO have osteoporosis! The number of fractures is significantly higher in people with other factors than low ABOUT. Only in much smaller groups with the oldest population of osteoporosis can cause damage. At this stage we need to consider the nature, and as a source of bone susceptibility to low-energy fractures. This, in turn, requires a redefinition of our - the responsibility of doctors to patients. The duty is to assess, not the risk of osteoporosis, but first and chiefly because the risk of fractures, regardless of its cause. At a conference in 2000, NIH Osteoporosis is defined as a skeletal disease characterized by bone strength risk reflects the quality and quantity of failure. (7)
General as it should be a definition illustrates the current knowledge (or rather, helplessness) and offers new possibilities for the diagnosis of osteoporosis. We have no instrument able to evaluate all the elements that determine the strength of the bones or the threshold of resistance to fracture, for example, as a result of minor trauma such as falling from his own height. Using general terms, the uncertainty they are, we define osteoporosis fractures have low energy fracture, which will bear no consequences for most people. Osteoporosis can not be put to such a low power failure occurs. As myocardial infarction can not be recognized until it happens. Even being fully armed with knowledge as a bone we can not assess the risk of fractures without the influence of extra-bone factors. Example: in two patients with the same condition of the bones. One of them suffered a fracture through the fall. In this case, osteoporosis was diagnosed only that part is absolutely bone factor. Obviously, the study of bone is only one of several steps leading to the recognition of fracture risk. With this in mind, what tools we need to assess the risk of fractures? It is helpful to use epidemiological data on risk factors for fracture (BCM), which can be calculated as relative risk (PR) of FRF increases the risk of fractures in all patients compared with the population risks. For example, in the case of myocardial infarction (MI), as is the risk of myocardial infarction is higher in patients with diabetes, high blood pressure, obesity, dyslipidemia, or smoking? Or, as in the case of osteoporosis, as the risk of fractures is higher in people with history of low-energy fracture, who smokes and has undergone treatment with glycocorticosteroids? The database was created a working group of WHO all epidemiological studies conducted in the same medical standards lasix purchase. (8) They found independent risk factors. This independence means that a factor acting independently increases the risk of fractures compared with the population risks. Obviously, the more factors working at the same time the greater risk. The methodology of assessment of 10 years ('10 adopted as the optimal period) absolutely individual fracture risk (AR-10) of the hip joint are presented in the AR-10 calculator. This helps assess the risk of fractures in each person, in any age and includes all known independent factors (low IPC with Z-score below 0. 0 is one of them) that affect the subject or population. We strongly advocate for the evaluation of the individual, absolute, 10-year risk of hip fractures as a diagnostic which determines the threshold of intervention. And we define osteoporosis at high risk of fractures. Kanis JA. and other cooperation. : Assessment of fracture risk. Osteoporos Int 2005, 16, 6:581.
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