Who's at risk?
Because bone loss is gradual and painless, there are usually no symptoms to indicate a person is developing osteoporosis. This is why osteoporosis is often referred to as a silent disease. Often the first symptom of osteoporosis is a fracture. Most commonly, osteoporotic fractures occur at the spine, the wrist or the hip, although osteoporotic fractures can occur in other bones as well.
Since the clinical outcome of osteoporosis is bone fracture, attention is now increasingly focused on the identification of patients at high risk of fracture in addition to the identification of people with osteoporosis as defined by bone mineral density (BMD) alone Dawson-Hughes, B., et al., Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA. Osteoporos Int, 2008. 19(4): p. 449-58.
Fujiwara, S., et al., Development and application of a Japanese model of the WHO fracture risk assessment tool (FRAX). Osteoporos Int, 2008. 19(4): p. 429-35.
Kanis, J.A., et al., FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int, 2008. 19(4): p. 385-97.
Leslie, W.D., Absolute fracture risk reporting in clinical practice: a physician-centered survey. Osteoporos Int, 2008. 19(4): p. 459-63.
Siris, E. and P.D. Delmas, Assessment of 10-year absolute fracture risk: a new paradigm with worldwide application. Osteoporos Int, 2008. 19(4): p. 383-4.
Tosteson, A.N., et al., Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int, 2008. 19(4): p. 437-47.
. BMD is one component of fracture risk, therefore accurate assessment of fracture risk should ideally take into account other proven risk factors that add information to that provided by BMD. The integration of multiple risk factors is now possible, with the development of risk assessment tools such as FRAX®.
While most limb fractures (such as at the wrist or hip) are clinically obvious, spinal fractures can be more difficult to diagnose. This is because they might be painless, or if there is pain, a person may not know it is caused by a fracture due to the many different causes of back pain. More obvious signs of spinal fractures are, for example, loss of height and/or development of a curved upper back (sometimes called a Dowager's Hump).
Due to the usual lack of outward signs of osteoporosis developing, testing if often recommended depending on age and the presence of other risk factors for the disease.
What are risk factors?
Many factors influence an individual’s propensity to develop osteoporosis and suffer the fragility fractures it causes. A risk factor is anything that increases your chance of suffering from a disease or experiencing an event. Having a risk factor, or even several, does not mean that you will have osteoporosis. However, the more risk factors you have, the greater your chance of developing a disease and also, the greater the level of each risk factor, the greater the risk De Laet, C., et al., The impact of the use of multiple risk indicators for fracture on case-finding strategies: a mathematical approach. Osteoporos Int, 2005. 16(3): p. 313-8.
There are two different kinds of risk factors – fixed or modifiable; some factors, such as age or gender, are non-modifiable; whereas, others are linked to personal lifestyle choices, such as smoking, alcohol intake and diet, which can be avoided or ameliorated. Individuals can act to reduce modifiable risks and, although there is no way to control fixed risks, there are strategies that can lessen their effect.