Kanis, J Bone Miner Res 1994 - The Diagnosis of Osteoporosis

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The Diagnosis of Osteoporosis

Kanis, Khaltaev, et al.·J Bone Miner Res·1994·3,840 citations·Review article

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Kanis and colleagues asked how the continuous relationship between bone mineral density (BMD) and fracture risk could be converted into diagnostic categories for osteoporosis. Perspective paper using lifetime fracture risk estimates for white women aged 50 and BMD data from 100 Sheffield patients to set thresholds referenced to the young adult mean.

Key Findings

Diagnostic categories by BMD relative to the young adult mean (T-score):
- Normal: above −1 SD
- Osteopenia: −1 to −2.5 SD
- Osteoporosis: below −2.5 SD
- Severe (established) osteoporosis: below −2.5 SD plus one or more fragility fractures
The −2.5 SD cutoff is pragmatic. It labels about 30% of postmenopausal women osteoporotic at spine, hip or forearm, close to their 39.7% lifetime risk of any major fragility fracture.
Fracture risk rises 1.5- to 3-fold per SD fall in BMD. Lifetime hip fracture risk is about 15% at average BMD, 30% at 1 SD below and 60% at 2 SD below.
Osteoporosis prevalence by measurement site (100 Sheffield patients):
- Wrist: 7%
- Spine: 10%
- Either site: 14%
- Both sites: 3%
Significance: The paper set out the WHO T-score framework for diagnosing osteoporosis and argued that age-matched Z-scores hide the rise in absolute fracture risk with age, so they are unsuitable for diagnosis.

Board PearlA BMD more than 2.5 SD below the young adult mean is osteoporosis, and the same BMD with a fragility fracture is severe (established) osteoporosis.

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The Diagnosis of Osteoporosis

Kanis, Khaltaev, et al.·J Bone Miner Res·1994·3,840 citations·Review article

|

Kanis and colleagues asked how the continuous relationship between bone mineral density (BMD) and fracture risk could be converted into diagnostic categories for osteoporosis. Perspective paper using lifetime fracture risk estimates for white women aged 50 and BMD data from 100 Sheffield patients to set thresholds referenced to the young adult mean.

Key Findings

Diagnostic categories by BMD relative to the young adult mean (T-score):
- Normal: above −1 SD
- Osteopenia: −1 to −2.5 SD
- Osteoporosis: below −2.5 SD
- Severe (established) osteoporosis: below −2.5 SD plus one or more fragility fractures
The −2.5 SD cutoff is pragmatic. It labels about 30% of postmenopausal women osteoporotic at spine, hip or forearm, close to their 39.7% lifetime risk of any major fragility fracture.
Fracture risk rises 1.5- to 3-fold per SD fall in BMD. Lifetime hip fracture risk is about 15% at average BMD, 30% at 1 SD below and 60% at 2 SD below.
Osteoporosis prevalence by measurement site (100 Sheffield patients):
- Wrist: 7%
- Spine: 10%
- Either site: 14%
- Both sites: 3%
Significance: The paper set out the WHO T-score framework for diagnosing osteoporosis and argued that age-matched Z-scores hide the rise in absolute fracture risk with age, so they are unsuitable for diagnosis.

Board PearlA BMD more than 2.5 SD below the young adult mean is osteoporosis, and the same BMD with a fragility fracture is severe (established) osteoporosis.

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