Osteoporosis risk factors after the menopause

Osteoporosis is a disease of the skeleton commonly associated with low bone mass and is predominant in elderly, post-menopausal women. Elza Fonseca of the Polytechnic Institute of Bragança and colleagues there and at the Medical Imaging Centre in Porto, point out that osteoporosis was common in the group of Portuguese women studied. They discuss data from different geographic regions concerning this public health problem.

The team hoped to identify common factors and so underpin knowledge on this potentially debilitating and critical bone disease. The clinical relevance is that those with the condition are highly susceptible to bone fractures, which can lead to pain, hospitalisation and disablement, particularly in the case of hip, spine and wrist fracture. Indeed, fractures linked to osteoporosis are unfortunately often linked to patient death.

Bone mass density as determined by dual energy X-ray absorptiometry (DEXA) has been used frequently to determine whether a particular patient is at increased risk of fracture, it also provides a quantitative marker for osteoporosis, which is defined as having BMD 2.5 standard deviations below average. Osteopenia, a precursor condition to osteoporosis, is marked by a BMD 1.0 to 2.5 below average.

The researchers point out that, controversy exists among experts regarding the value of BMD as a diagnostic criterion for osteoporosis. They explain that there is good evidence to support the cost-effectiveness and efficacy of early prescription of preventive drugs, but it is not clear at which point below the threshold this should be. Their new study on lifestyle and other risk factors should couple neatly with such discussions and allow more informed decisions to be made regarding the use of drugs in patients with signs of osteopenia who may, or may not, go on to develop osteoporosis.