Authors' objectives:

The objectives of this study were:

1. To assess the clinical utility of bone densitometry (BD) as a prognostic tool (capacity to predict osteoporotic fractures)

2. To identify fracture risk factors (RFs), both related and unrelated to a decrease or alteration of BM (osteoporotic fractures, due to bone fragility, or non-traumatic), and to describe its associated fracture risk

3. To classify fracture RFs related to low bone mass according to the associated magnitude of the fracture risk

4.To propose guidelines for the indication of BD in the assessment of the individual risk of fracture.

Authors' recommendations: There is an association between low BM and a higher fracture risk, but BD has a low capacity for predicting future fractures in subjects without a high fracture risk,and therefore many patients are incorrectly classified regarding their possibility of suffering a fracture based on the results of this test. Individual assessment of the different fracture RFs (type and number, especially those related to a decrease in BM)may help to identify individuals who are particularly prone to future fractures; thus, the presence of a simultaneous RF may imply better appropriateness of the indication of BD. No study was identified which analysed the clinical utility of BD in specific population subgroups with high RF risk. Only a low rate (40%)of all the possible fracture RFs associated with a low BM and studied in the reviewed literature could be classified according to the magnitude of their association. Other factors, not related to a decrease of BM, and associated with the appearance of fractures were found. These factors should also be considered when assessing individual risk factors. The ones associated with high fracture risks were some socio-demographic risks (living away from home and lower educational levels); epilepsy and stroke; high energy falls,impacts on hip or risk activities in the elderly;consumption of psychotropes; previous fractures, and nearly all RFs related to health status, functional capacity and morbidity. Visual disorders and alteration of the cognitive status would be associated with moderate racture risk. Scientific evidence also showed that the origin of fractures is multifactorial, and that there are different RFs, related or unrelated to a decrease of BM, associated with the appearance of fractures.Osteoporosis (defined as an excessive BM loss)is just another factor among the different fracture RFs. Some studies found that the higher the number of fracture RFs present (both related and unrelated to a decrease of BM), the higher the risk of fractures, especially hip fractures.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.gencat.net/salut/depsan/units/aatrm/html/en/dir393/doc7921.ht ml

Year Published: 1999

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Agencia de Qualitat i Avaluacio Sanitries de Catalunya

Contact Address: Antoni Parada, CAHTA, Roc Boronat, 81-95 (2nd floor), 08005 Barcelona, Spain, Tel. +34 935 513 928, Fax: +34 935 517 510

Contact Name: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Contact Email: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Copyright: Catalan Agency for Health Technology Assessment and Research (CAHTA)