Recommendations for Bone Mineral Density Reporting in Canada: A Shift to Absolute Fracture Risk Assessment

Siminoski, Kerry; Leslie, William D.; Frame, Heather; Hodsman, Anthony; Josse, Robert G.; Khan, Aliya; Lentle, Brian C.; Levesque, Jacques; Lyons, David J.; Tarulli, Giuseppe; Brown, Jacques P.

doi:10.1016/j.jocd.2007.01.001

« Previous Next »Journal of Clinical Densitometry
Volume 10, Issue 2 , Pages 120-123, April 2007

Recommendations for Bone Mineral Density Reporting in Canada: A Shift to Absolute Fracture Risk Assessment

Kerry Siminoski
- Department of Radiology and Diagnostic Imaging and Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, Canada
- Address correspondence to: Dr Kerry Siminoski, 6628-123 Street, University of Alberta, Edmonton, Alberta, Canada, T6H 3T6.
William D. Leslie
- Department of Medicine and Department of Radiology, University of Manitoba, Winnipeg, Canada
Heather Frame
- Department of Continuing Medical Education, University of Manitoba, Winnipeg, Canada
Anthony Hodsman
- Department of Medicine, University of Western Ontario, London, Canada
Robert G. Josse
- Department of Medicine, University of Toronto, Toronto, Canada
Aliya Khan
- Department of Medicine, McMaster University, Hamilton, Canada
Brian C. Lentle
- Department of Radiology, University of British Columbia, Vancouver, Canada
Jacques Levesque
- Department of Radiology, Le Centre hospitalier universitaire de Quebec, Sainte-Foy, Canada
David J. Lyons
- Department of Diagnostic Imaging, Renfrew Victoria Hospital, Renfrew, Canada
Giuseppe Tarulli
- Department of Medical Imaging, Humber River Regional Hospital, Toronto, Canada
Jacques P. Brown
- Department of Medicine, Laval University, Sainte-Foy, Canada

Received 6 November 2006; received in revised form 31 December 2006; accepted 2 January 2007. published online 19 February 2007.

Abstract

In June 2005, new Canadian recommendations for bone mineral density (BMD) reporting in postmenopausal women and older men were published by Osteoporosis Canada (formerly the Osteoporosis Society of Canada) and the Canadian Association of Radiologists. The recommendations were developed by a multidisciplinary working group that included the Canadian Panel of the International Society for Clinical Densitometry and were reviewed and endorsed by multiple stakeholders. Previous Canadian osteoporosis guidelines advised intervention based on an individual's World Health Organization category (normal, osteopenia, or osteoporosis) as a marker of relative fracture risk. In the new approach, an individual's 10-yr absolute fracture risk, rather than BMD alone, is used for fracture risk categorization. Absolute fracture risk is determined using not only BMD results, but also age, sex, fragility fracture history, and glucocorticoid use. A procedure is presented for estimating absolute 10-yr fracture risk in untreated individuals, leading to assigning an individual to 1 of 3 absolute fracture risk categories: low risk (<10% 10-yr fracture risk), moderate risk (10–20%), and high risk (>20%). We propose that an individual's absolute fracture risk category should be the basis for deciding on treatment and frequency of BMD monitoring.

Key Words: Bone mineral densitometry, dual-energy X-ray absorptiometry, fracture, guidelines, osteopenia, osteoporosis