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UnlabelledThe Committee of Scientific Advisors of International Osteoporosis Foundation (IOF) recommends that papers describing the descriptive epidemiology of osteoporosis using bone mineral density (BMD) at the femoral neck include T-scores derived from an international reference standard.IntroductionThe prevalence of osteoporosis as defined by the T-score is inconsistently reported in the literature which makes comparisons between studies problematic.MethodsThe Epidemiology and Quality of Life Working Group of IOF convened to make its recommendations and endorsement sought thereafter from the Committee of Scientific Advisors of IOF.ResultsThe Committee of Scientific Advisors of IOF recommends that papers describing the descriptive epidemiology of osteoporosis using BMD at the femoral neck include T-scores derived from the National Health and Nutrition Examination Survey III reference database for femoral neck measurements in Caucasian women aged 20-29 years.ConclusionsIt is expected that the use of the reference standard will help resolve difficulties in the comparison of results between studies and the comparative assessment of new technologies.

An editorial is presented on the approaches to improving the management and treatment of patients with osteoporotic fractures are increasingly advocated in many countries. It outlines the management of those presenting with nonhip fractures is also addressed through the establishment of Fracture Liaison Services. An overview of the systematic approaches for the identification of high fracture risk is presented.

Byline: G. Martinez Diaz-Guerra (1), F. Hawkins (1), A. Rapado (2), M. A. Ruiz Diaz (3), M. Diaz-Curiel (2) Keywords: Key words:Bone mineral density -- iPTH -- Men -- Sex hormone binding globulin Abstract: Osteoporosis in men is a significant health problem, and factors associated with bone mass are being investigated. Although osteoporosis is a typical feature of hypogonadism, the influence of testosterone levels and other hormonal factors on bone mass of eugonadal males is unknown. Our aim was to identify several anthropometric and hormonal predictors that could be responsible for the variability in bone mineral density (BMD) in healthy men. One hundred elderly men (age 68 +- 7 years) were investigated in this cross-sectional study. BMD was measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and femoral sites (femoral neck, Ward's triangle, trochanter, intertrochanter and total femur). Anthropometric measures were obtained including: weight, height, body mass index (BMI), waist--hip ratio and testicular volume. Hormonal data measures were total, free and bioavailable testosterone, dihidrotestosterone, estradiol, sex hormone binding globulin (SHBG), insulin-like growth factor I (IGF-I), intact parathyroid hormone (iPTH) and 1,25-dihydroxyvitamin D.sub.3 (1,25(O[H).sub.2]D.sub.3). One subject was excluded because primary hypogonadism was found. SHBG levels were increased in 53.5% of men, and 8% showed a mild increase in iPTH levels. Twenty-eight subjects had densitometric criteria of osteoporosis (T-score a$?-2.5). All BMD sites were positively correlated with body weight (r= 0.29--0.48, p&lt 0.001) and BMI (r= 0.24--0.47, p&lt 0.001). A negative correlation between SHBG levels and intertrochanter (IT) and total femur (TL) BMD was found (r=-0.24 and r=-0.22, p&lt 0.05). After adjusting for age and BMI, SHBG and IGF-I levels were negatively correlated (r=-0.33, p&lt 0.001). In multiple linear regression analysis independent predictors of bone mass were body weight, SHBG and iPTH levels. The best predictive model accounted for 24--40% of the observed variability of BMD. However, most of the BMD variability was explained by body weight. In conclusion, in our study body weight, SHBG and iPTH levels were predictors of BMD in healthy elderly men. Author Affiliation: (1) Endocrinology Service, University Hospital 12 de Octubre (HDO), ES (2) Metabolic Unit, Fundacion Jimenez Diaz (FJD) , ES (3) Department of Methodology, Faculty of Psychology, Autonoma University of Madrid, Madrid, Spain, ES Article note: Received: 9 June 2000 / Accepted: 27 September 2000

Byline: C. Gomez Alonso (1), M. Diaz Curiel (2), F. Hawkins Carranza (3), R. Perez Cano (4) Keywords: Key words: Accidental falls -- Densitometry, X-ray -- Femur neck -- Fractures, prevention and control -- Hip fractures -- Osteoporosis, complications Abstract: The effect of femoral bone mineral density (BMD) and several parameters of femoral neck geometry (hip axis length, neck--shaft angle and mean femoral neck width) on hip fracture risk in a Spanish population was assessed in a cross-sectional study. All parameters were determined by dual-energy X-ray absorptiometry. There were 411 patients (116 men, 295 women aged 60--90 years) with hip fractures in whom measurements were taken in the contralateral hip. Controls were 545 persons (235 men, 310 women aged 60--90 years) who participated in a previous study on BMD in a healthy Spanish population. Femoral neck BMD was significantly lower, and neck--shaft angle and mean femoral neck width significantly higher, in fracture cases than in controls. The logistic regression analysis adjusted by age, height and weight showed that a decrease of 1 standard deviation (SD) in femoral neck BMD was associated with an odds ratio of hip fracture of 4.52 [95% confidence interval (CI) 2.93 to 6.96] in men and 4.45 (95% CI 3.11 to 6.36) in women an increase of 1 SD in neck--shaft angle of 2.45 (95% CI 1.73 to 3.45) in men and 3.48 (95% CI 2.61 to 4.65) in women and an increase of 1 SD in mean femoral neck width of 2.15 (95% CI 1.55 to 2.98) in men and 2.40 (95% CI 1.79 to 3.22) in women. The use of a combination of femoral BMD and geometric parameters of the femoral neck except for hip axis length may improve hip fracture risk prediction allowing a better therapeutic strategy for hip fracture prevention. Author Affiliation: (1) Servicio de Metabolismo Aseo y Mineral, Instituto Reivia Sofia de Investigacion, Hospital Central de Asturias, Oviedo, ES (2) Unidad Metabolica, Fundacion Jimenez Diaz, Madrid, ES (3) Departamento de Endocrinologia, Hospital Doce de Octubre, Madrid, ES (4) Departamento de Medicina Interna, Hospital Virgen de la Macarena, Sevilla , ES (5) Servicio de Medicina Interna, Hospital del Mar, Barcelona, Spain, ES Article note: Received: 16 September 1999 / Accepted: 22 February 2000

Introduction: Postmenopausal osteoporosis is a chronic disease requiring treatment that balances long-term fracture efficacy against risk.Methods: We reviewed the efficacy and safety of calcium and vitamin D, the selective estrogen receptor modulators (SERMs), the bisphosphonates, denosumab, and strontium ranelate in studies of 3 years or longer.Results: Six trials lasted for 5 years, and seven went beyond that. The evidence beyond 5 years is generally weak, mainly due to methodological issues (open-label design, small samples, or absence of placebo control). Although calcium and vitamin D appear to be beneficial, the data are insufficient to evaluate benefits and risk beyond 3 years. The fracture efficacy of SERMs beyond 5 years is not known, though increases in bone mineral density (BMD) appear to be maintained. The SERMs have good long-term safety, including protective effects against breast cancer. The bisphosphonates have established fracture efficacy to 3 years, and 4 or 5 years with alendronate and risedronate. The evidence beyond 5 years indicates sustained increases in BMD. The safety of the bisphosphonates does not appear to be modified with time, with the possible exceptions of atypical subtrochanteric fracture and other events of unknown frequency. Denosumab has been tested up to 5 years, with continued increased in BMD and no reported safety issues. There is evidence for fracture efficacy of strontium ranelate, and sustained increases in BMD over 10 years. Strontium ranelate has good long-term safety.Conclusion: Robust long-term studies are relatively rare for the osteoporosis treatments, and generally show maintenance of BMD and, for some agents, an additional reduction in fracture incidence. [ABSTRACT FROM AUTHOR]