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Osteoporosis is a serious health concern affecting millions of Americans, with many patients going undiagnosed and untreated. Fractures due to osteoporosis and fracture-related complications are the most clinically relevant and costly consequences of this disorder. The Fracture Risk Assessment Tool (FRAX®), released by the World Health Organization (WHO) in February 2008, is a major achievement in helping determine which patients may be candidates for pharmacological therapy for osteoporosis. This Web-based algorithm, which has been incorporated into some dual x-ray absorptiometry (DXA) reporting software, calculates the 10-year probability of major osteoporotic fracture (clinical vertebral, hip, forearm, or humerus) and the 10-year probability of hip fracture in men and women based on easily obtained clinical risk factors and bone mineral density (BMD) of the femoral neck (optional). The National Osteoporosis Foundation updated its U.S. guidelines in February 2008 to incorporate FRAX and recommends that all postmenopausal women and men aged ≥50 years with a hip or vertebral fracture, a T-score ≤−2.5 at the femoral neck or spine (excluding secondary causes), or low bone mass (T-score between −1.0 and −2.5) and a 10-year probability of hip fracture ≥3% or of major osteoporosis-related fracture ≥20% (based on FRAX) should be considered candidates for drug therapy. Despite its demonstrated clinical utility, FRAX has limitations and should not be used in all situations. Acceptance and clinical use of FRAX may help identify men and women at increased risk for osteoporotic fracture, but implementing the tool into clinical practice may be a challenge for busy physicians. [ABSTRACT FROM AUTHOR]

Presents a study to test the efficacy and safety of daily treatment with risedronate to reduce the risk of vertebral and other fractures in postmenopausal women with established osteoporosis. Context; Design, setting and participants; Interventions; Main outcome measures; Results; Conclusions.

Osteoporosis is a major public health problem but is underdiagnosed and undertreated. A new randomized controlled trial indicates that population screening for osteoporosis by BMD assessment resulted in improved treatment and reduced risk of fractures in postmenopausal women. [ABSTRACT FROM AUTHOR]

Objectives To determine the proportion of untreated women who reported receiving treatment after incident fracture and to identify factors that predict treatment across an international spectrum of individuals. Design Prospective observational study. Self-administered questionnaires were mailed at baseline and 1 year. Setting Multinational cohort of noninstitutionalized women recruited from 723 primary physician practices in 10 countries. Participants Sixty thousand three hundred ninety-three postmenopausal women aged 55 and older were recruited with a 2:1 oversampling of women aged 65 and older. Measurements Data collected included participant demographics, medical history, fracture occurrence, medications, and risk factors for fracture. Anti-osteoporosis medications ( AOMs) included estrogen, selective estrogen receptor modulators, bisphosphonates, calcitonin, parathyroid hormone, and strontium. Results After the first year of follow-up, 1,075 women reported an incident fracture. Of these, 17% had started AOM, including 15% of those with a single fracture and 35% with multiple fractures. Predictors of treatment included baseline calcium use ( P = .01), baseline diagnosis of osteoporosis ( P < .001), and fracture type ( P < .001). In multivariable analysis, women taking calcium supplements at baseline (odds ratio ( OR) = 1.67) and with a baseline diagnosis of osteoporosis ( OR = 2.55) were more likely to be taking AOM. Hip fracture ( OR = 2.61), spine fracture ( OR = 6.61), and multiple fractures ( OR = 3.79) were associated with AOM treatment. Age, global region, and use of high-risk medications were not associated with treatment. Conclusion More than 80% of older women with new fractures were not treated, despite the availability of AOM. Important factors associated with treatment in this international cohort included diagnosis of osteoporosis before the incident fracture, spine fracture, and to a lesser degree, hip fracture. [ABSTRACT FROM AUTHOR]

This study examined patients' risk profiles and adherence to treatment in relation to the effect of risedronate and raloxifene on hip fracture incidence. Administrative billing data were used to follow two cohorts of women aged 65 and older after starting therapy with either risedronate (n = 86,735) or raloxifene (n = 37,726). The fracture risk profile was described using a 6-month history period before starting therapy. Effectiveness of each therapy was evaluated by comparing the incidence of hip fractures during the first 3 months with the subsequent 12 months among women adherent (medication possession ratio >80%) compared with those non-adherent to treatment. At the start of therapy, the raloxifene cohort was younger than the risedronate cohort (median age 73 vs. 76 years) and had fewer prior fractures (p < 0.01 for both). In the first 3 months of therapy, hip fracture incidence was lower in the raloxifene group (0.51 per 100 person-years) compared with the risedronate group (0.94 per 100 person-years). In the subsequent 12 months, the incidence of hip fractures decreased among patients adherent to the risedronate regimen [relative risk (RR) 0.70, 95% CI 0.59-0.84, p < 0.01] and did not change significantly among patients adherent to the raloxifene regimen (RR 1.02, 95% CI 0.73-1.44). In poorly adherent patients, neither drug decreased hip fracture risk. Risedronate treatment in adherent patients rapidly decreased the risk of hip fractures, whereas raloxifene treatment did not. [ABSTRACT FROM AUTHOR]

The article focuses on proper handling and long-term care of patients suffering from osteoporosis with prior fracture. It states that the proper management of the disease is critical to prevent risks for recurrent fractures. The World health Organization (WHO) has introduced fracture prediction algorithm (FRAX) to be able to absolutely predict fracture risks using the body mass index of the patient. Discussions of the other possible therapies that may be applied for osteoporosis are provided.