William D Leslie1, Suzanne N Morin2. 1. Departments of Medicine and Radiology, University of Manitoba, 409 Tache Avenue, Winnipeg, Manitoba, R2H 2A6, Canada. bleslie@sbgh.mb.ca. 2. Department of Medicine, McGill University- McGill University Health Center, Montreal, Quebec, Canada.
Abstract
PURPOSE OF REVIEW: Identifying individuals at high fracture risk can be used to target those likely to derive the greatest benefit from treatment. This narrative review examines recent developments in using specific risk factors used to assess fracture risk, with a focus on publications in the last 3 years. RECENT FINDINGS: There is expanding evidence for the recognition of individual clinical risk factors and clinical use of composite scores in the general population. Unfortunately, enthusiasm is dampened by three pragmatic randomized trials that raise questions about the effectiveness of widespread population screening using clinical fracture prediction tools given suboptimal participation and adherence. There have been refinements in risk assessment in special populations: men, patients with diabetes, and secondary causes of osteoporosis. New evidence supports the value of vertebral fracture assessment (VFA), high resolution peripheral quantitative CT (HR-pQCT), opportunistic screening using CT, skeletal strength assessment with finite element analysis (FEA), and trabecular bone score (TBS). The last 3 years have seen important developments in the area of fracture risk assessment, both in the research setting and translation to clinical practice. The next challenge will be incorporating these advances into routine work flows that can improve the identification of high risk individuals at the population level and meaningfully impact the ongoing crisis in osteoporosis management.
PURPOSE OF REVIEW: Identifying individuals at high fracture risk can be used to target those likely to derive the greatest benefit from treatment. This narrative review examines recent developments in using specific risk factors used to assess fracture risk, with a focus on publications in the last 3 years. RECENT FINDINGS: There is expanding evidence for the recognition of individual clinical risk factors and clinical use of composite scores in the general population. Unfortunately, enthusiasm is dampened by three pragmatic randomized trials that raise questions about the effectiveness of widespread population screening using clinical fracture prediction tools given suboptimal participation and adherence. There have been refinements in risk assessment in special populations: men, patients with diabetes, and secondary causes of osteoporosis. New evidence supports the value of vertebral fracture assessment (VFA), high resolution peripheral quantitative CT (HR-pQCT), opportunistic screening using CT, skeletal strength assessment with finite element analysis (FEA), and trabecular bone score (TBS). The last 3 years have seen important developments in the area of fracture risk assessment, both in the research setting and translation to clinical practice. The next challenge will be incorporating these advances into routine work flows that can improve the identification of high risk individuals at the population level and meaningfully impact the ongoing crisis in osteoporosis management.
Authors: Ines Foessl; J H Duncan Bassett; Åshild Bjørnerem; Björn Busse; Ângelo Calado; Pascale Chavassieux; Maria Christou; Eleni Douni; Imke A K Fiedler; João Eurico Fonseca; Eva Hassler; Wolfgang Högler; Erika Kague; David Karasik; Patricia Khashayar; Bente L Langdahl; Victoria D Leitch; Philippe Lopes; Georgios Markozannes; Fiona E A McGuigan; Carolina Medina-Gomez; Evangelia Ntzani; Ling Oei; Claes Ohlsson; Pawel Szulc; Jonathan H Tobias; Katerina Trajanoska; Şansın Tuzun; Amina Valjevac; Bert van Rietbergen; Graham R Williams; Tatjana Zekic; Fernando Rivadeneira; Barbara Obermayer-Pietsch Journal: Front Endocrinol (Lausanne) Date: 2021-12-01 Impact factor: 5.555