Access; Bone health; Epidemiology; Inequity; Management; Osteoporosis; Humans; Osteoporotic Fractures/prevention & control; Osteoporotic Fractures/etiology; Bone Density/physiology; Global Health; Absorptiometry, Photon; Risk Factors; Risk Assessment/methods; Osteoporosis/therapy; Osteoporosis/diagnosis; Osteoporosis/physiopathology; Health Services Accessibility/organization & administration; Bone Density; Health Services Accessibility; Osteoporotic Fractures; Risk Assessment; Endocrinology, Diabetes and Metabolism
Abstract :
[en] Our ability to optimally manage bone health across the lifecourse, and so minimise the risk of fractures, has advanced substantially in recent decades. Whilst fractures and osteoporosis in older age were historically viewed simply as inherent in normal ageing, they are now recognised as manifestations of age-related disease. Key to advancing the field was the development of conceptual (relating to impaired bone mass and microarchitecture with increased propensity to fracture), and subsequent World Health Organization densitometric definitions of osteoporosis, cementing the role of dual-energy X-ray absorptiometry in bone health management. However, whilst low bone mineral density is a strong risk factor for fracture, many individuals who do fracture have normal or only modestly reduced bone mineral density. Furthermore, the existence of two definitions constituting a condition called "osteoporosis", one based on a measurement, and the other conceptual, has led to uncertainty in clinical practice. The field is therefore moving towards calculation of an individual's absolute fracture risk, based on clinical risk factors, with the option to incorporate bone mineral density (if available) as a risk factor rather than as an indication for treatment. Uptake of this new direction has been variable internationally, with many parts of the world, particularly low- and middle-income countries, still predicating treatment (where osteoporosis services exist) on bone mineral density, despite poor availability of densitometry in many such settings. In this Position Paper, on behalf of the International Osteoporosis Foundation, we review the current barriers which prevent equitable access to optimal bone health management worldwide and recommend potential solutions which might be implemented to overcome them.
Disciplines :
Laboratory medicine & medical technology Public health, health care sciences & services
Author, co-author :
Harvey, Nicholas C ; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK. nch@mrc.soton.ac.uk ; NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK. nch@mrc.soton.ac.uk
Al-Daghri, Nasser ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé ; Chair for Biomarkers of Chronic Diseases, Biochemistry Dept., College of Science, King Saud University, 11451, Riyadh, Saudi Arabia
Beaudart, Charlotte ; Université de Liège - ULiège > Département des sciences de la santé publique > Epidémiologie générale ; Public Health Aging Research & Epidemiology (PHARE) Group, Research Unit in Clinical Pharmacology and Toxicology (URPC), Department of Biomedical Sciences- Faculty of Medicine, NAmur Research Institute for LIfe Sciences (NARILIS), University of Namur, Namur, Belgium
Brandi, Maria Luisa ; FirmoLab, FIRMO Foundation, Florence, Italy
Burlet, Nansa ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Campusano, Claudia ; Clínica Universidad de los Andes and Faculty of Medicine, Universidad de los Andes, Santiago, Chile
Cavalier, Etienne ; Université de Liège - ULiège > Département de pharmacie > Chimie médicale
Chandran, Manju; Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore ; DUKE NUS Medical School, Singapore, Singapore
Cooper, Cyrus ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé ; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK ; NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
Dawson-Hughes, Bess; Jean Mayer USDA HUMAN Nutrition Research Center On Aging at Tufts University, Boston, MA, USA
Halbout, Philippe; International Osteoporosis Foundation, Nyon, Switzerland
Hough, Teréza; National Osteoporosis Foundation of South Africa (NOFSA), Cape Town, South Africa
Lazaretti-Castro, Marise; Metabolic Bone Diseases Unit, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil ; Brazilian Society of Endocrinology and Metabolism (SBEM), Rio de Janeiro, Brazil
Matijevic, Radmila ; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
Mithal, Ambrish ; Institute of Diabetes and Endocrinology, Max Healthcare, New Delhi, 110017, India
Njeze, Ngozi ; Department of Radiation Medicine, University of Nigeria Medical School, Enugu Campus- Nsukka, Nigeria
Rizzoli, René ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé ; Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
Saleh, Yousef; Health Oasis Hospital Riyadh, Riyadh, Saudi Arabia
Kanis, John A ; Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK ; Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
Ward, Kate ; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK ; NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
McCloskey, Eugene ; Mellanby Centre for Musculoskeletal Research, Division of Clinical Medicine, School of Medicine and Population Health, Sheffield, UK ; Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK
We are very grateful to Dr Dominique Pierroz, Lorele\u00EF Demullier and Laura Misteli, International Osteoporosis Foundation, for editorial and administrative support. NCH and KW are supported by the UK Medical Research Council (MRC) [MC_PC_21003; MC_PC_21001], National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK. NCH is additionally supported by NIHR (as an NIHR Senior Investigator, NIHR305844).This work was supported by the International Osteoporosis Foundation.
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