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Practice Algorithm
New NOF Osteoporosis Guidelines*
Raymond E. Cole, DO, CCD
In February 2008, the National Osteoporosis Foundation (NOF) issued
new guidelines for clinicians on the evaluation and treatment of individuals
with low bone mass or osteoporosis. This new guide radically changes the
approach to determining fracture risk and providing treatment. It addresses
non-white postmenopausal women (eg, black, Asian, Latina) and, for the
first time, men older than 50 years of age. It recommends when to perform
bone mineral density testing, advises on clinical evaluation, defines
risk factors for falls, and proposes 5 steps to bone health for osteoporosis
prevention. This practice algorithm was developed from these new, evidence-based
guidelines, and should help clinicians better identify individuals at
high risk for osteoporosis with attendant fractures and ensure that those
at high risk are considered as candidates for treatment. The NOF treatment
guidelines are intended to serve as recommendations for clinical
decision making, not as rigid standards or rules. They are a reference
point to assist in the tailoring of treatment to individual patient circumstances.
A significant feature of the guide is FRAX, an updated algorithm
developed by the
World Health Organization for determining absolute fracture risk
in untreated people (www.shef.ac.uk/FRAX). Based on a 10-year fracture-risk
model and 10-year fracture probability, FRAX estimates the likelihood of
a bone fracture in the next 10 years due to osteoporosis or low bone mass.
The NOF has adapted this algorithm for use by US health care professionals,
incorporating fracture outcome and mortality data as well as cost-effectiveness
analysis.
The author reports no actual or potential conflicts of interest
in relation to this article.
*Based on the Clinician's Guide to the Prevention
and Treatment of Osteoporosis from the National Osteoporosis Foundation,
www.nof.org/professionals/Clinicians_Guide.htm.
Accessed July 22, 2008.
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Raymond E. Cole, DO, CCD, is Clinical Assistant Professor,
Department of Internal Medicine, Michigan State University College
of Osteopathic Medicine, East Lansing; and Director of Osteoporosis Testing
Center of Michigan,
Brooklyn, MI .
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