Current understanding of osteoporosis according to the position of the World Health Organization (WHO) and International Osteoporosis Foundation

Abstract

The study documents a general change of position on osteoporosis (definition, diagnosis, aim of treatment). Taking into consideration a multifactorial nature of bone fragility in osteoporosis we do not diagnose "osteoporosis" but a total, individual 10-year fracture risk (AR-10) on the basis of independent and self-sufficient risk factors. These are: advanced age, prior fragility fracture, parental history of proximal femur fracture, low BMI, low bone mass, glicocortycosteroids treatment, rheumatoid arthritis, smoking, overuse of alcohol. The treatment should be implemented in persons burdened with a fracture risk higher than a population risk. The intervention threshold is a result of an agreement and a result of work of various working groups of experts. According to Johnell AR-10 below 8% does not require a therapeutical intervention; above 14% justifies the treatment independently of BMD measurement. AR-10 between 8% and 14% is an indication for BMD measurement precising fracture risk. The aim of the treatment is to decrease fracture risk. It combines a limitation of fracture risk factors effects including fall prevention and improvement of bone quality with applying pharmacotherapy. This study highlights that a bone mineral measurement, so far accepted as a criteria for diagnosis of osteoporosis or its exclusion should not be made in aim of diagnosis but to evaluate an absolute fracture risk. Spinal X-rays are performed in aim to diagnose vertebral fractures, which mean a multiple increase of risk of further fractures. The principles of low bone mass differential diagnosis and current possibility of pharmacological treatment are also described. Guidelines for fall avoidance in fracture prevention are described.