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Title: Assessment of fracture risk and its application to screening for postmenopausal osteoporosis : report of a WHO study group [meeting held in Rome from 22 to 25 June 1992]
Other Titles: Evaluation du risque de fracture et son application au dépistage de l' ostéoporose post-ménopausique : rapport d' un groupe d' étude de l' OMS [réuni à Rome du 22 au 25 juin 1992]
Evaluación del riesgo de fractura y su aplicación en la detección de la osteoporosis postmenopáusica : informe de un grupo de estudio de la OMS
Authors: WHO Study Group on Assessment of Fracture Risk and its Application to Screening for Postmenopausal Osteoporosis
World Health Organization
Issue Date: 1994
Publisher: Geneva : World Health Organization
Relation: WHO technical report series ; 843
Language: Chinese
Italian
English
French
Russian
Spanish
Abstract: An expert technical assessment of the many factors that influence the risk of osteoporotic fracture in postmenopausal women and thus need to be considered when planning the most effective public health interventions. In view of growing awareness of the need to prevent and treat postmenopausal osteoporosis, the book aims to resolve several controversies concerning the usefulness of screening programmes, the appropriate target populations, the most effective methods for predicting fracture risk, techniques for assessment, and the comparative effectiveness of currently available preventive and therapeutic interventions. More than 450 references to the literature are included. The report opens with a detailed review of what is known about osteoporosis, the criteria for establishing diagnosis, the value of bone mineral density measurements as diagnostic and prognostic tools, factors that influence the morbidity and mortality caused by fractures at different sites, and the physiological determinants of bone loss and fracture risk. A review of the epidemiology of osteoporotic fractures is used to determine the size of the public health problem, to identify appropriate target populations for screening, and to define intervention thresholds. A large part of the report is devoted to a review of the advantages and limitations of three candidate methods for predicting future fracture risk: assessment of bone mass, assessment of bone loss, and clinical assessment of risk factors. Information on non-invasive physical techniques for bone mass assessment is especially detailed. Currently available techniques are described and discussed in terms of their performance characteristics, safety, accuracy, and suitability for use as screening tools. The report also evaluates various biochemical and other methods for the assessment of bone loss, lists the currently known risk factors and protective factors, and considers whether these factors can be used to identify high-risk individuals. A section devoted to the risks and benefits of intervention evaluates the efficacy and safety of hormone replacement therapy, using estro-gens alone or estrogens combined with progestogens, and other currently available interventions, including the use of calcium, calcitonins, and bisphosphonates. Particular attention is given to the assessment of evidence that estrogen replacement therapy might increase the risk of certain cancers and decrease the risk of morbidity and mortality from cardiovascular disease. The final section, on screening, reaches a number of important conclusions concerning the value, aims, target population, assessment methods, interventions, and organization of screening programmes for postmenopausal osteoporosis. These conclusions form the basis for several practical and technical recommendations useful to public health authorities as well as to clinicians seeking guidance on safe and effective ways to prevent osteoporotic fractures
Description: DC.HQ
129 p.
Subject: Osteoporosis, Postmenopausal
Bone Diseases
Estrogen Replacement Therapy
Fractures, Bone
Menopause
URI: http://www.who.int/iris/handle/10665/39142
Other Identifiers: 9241208430
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