MJA: Osteoporosis consensus statement, Australia 1997

The prevention and management of osteoporosis
Consensus statement

It is never too
late to treat low
bone density. Bone
loss continues in
old age and may
accelerate as bone
resorption increases.
A small decline in
bone mass results
in a disproportionate
rise in bone fragility.
Preventing bone loss,
even in the elderly,
has been shown to
prevent the increase
in fracture incidence
that would occur if
treatment had not
been given.

7. When should low bone density be treated?

AS DISCUSSED under Question 3, there is a continuous, inverse relationship between bone density and fracture risk. Like height and blood pressure, bone mineral content or density in young, healthy adults follows a normal distribution. This occurs regardless of the site measured or the technique used to measure it, although the absolute value is dependent on site, technique and instrumentation. Because of this distribution, an individual's bone density value may be related to a young, healthy, sex-matched reference population in terms of multiples of the standard deviation from the population mean ("T score"). Thus a value equal to the mean is ascribed a T score of 0, whereas values which fall, say, two standard deviations above or below the mean have T scores of +2 and -2, respectively.

Recently, a working party of the World Health Organization proposed diagnostic categories for thresholds of bone density based upon the distribution of skeletal mass in young, healthy individuals, using such T scores. In the absence of other clinical indications these categories suggest the action thresholds shown in Box 5.

5: Suggested action thresholds for osteoporosis

Next: What are the goals of treatment and how do you choose an appropriate management strategy for individual patients?

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