![]() ![]() Low sensitivity High availability Subclinical vertebral fracture is a strong risk factor for subsequent fractures at new vertebral site and other sitesĢ7 Assessment of fracture risk DXA and quantitative ultrasound Clinical risk factors Markers of bone turnover Bone formation Bone resorptionĢ8 Assessment of fracture risk DXA Risk of fracture = for each SD decrease in BMD Low sensitivity ( comparable to BP in predicting stroke ) Screening is not recommended Quantitative ultrasound Risk of fracture = for each SD decrease in BMDĢ9 Assessment of fracture risk Markers of bone turnover Bone formation markers Alkaline phosphatase Bone isoenzyme AP Osteocalcin Procollagen propeptides of type I collagen Bone resorption markers Hydroxyproline Pyridinium crosslinks & associated peptidesģ0 Assessment of fracture risk Markers of bone turnover Associated with osteoporotic fracture independent of bone density 2-Fold increase in fracture risk? Combined approach with BMD to increased sensitivityģ1 Assessment of fracture risk Clinical risk factors for fracture Low bone mass History or falls Impaired cognition ( plus medication adverse effect ) Low physical function Presence of environmental hazards Long hip axis length Chronic glucocorticoid use Existing fracture Chronic use of seizure medications Renal, hepatic, thyroid, parathyroid, malabsorptive disorder, vitamin D deficiency, MM and local neoplasia to be ruled out National Osteoporosis Foundation 1998ģ2 Assessment of fracture risk Predictors of low bone mass Female Advanced age Gonadal hormone deficiency ( estrogen or testosterone ) White race Low body weight & BMI Family history of osteoporosis Low calcium intake Smoking / excessive alcohol intake Low level of physical acitivity Chronic glucocorticoid use History of fracture National Osteoporosis Foundation 1998ģ3 Assessment of fracture risk The U.S. 24 CT scan True volumetric study Most useful in cancellous bone assessment Avoid effect of degenerative disease Drawback High cost High radiation exposure Difficult quality controlĢ5 Plain radiography QuickTime and a TIFF (Uncompressed) decompressor are needed to see this picture. ![]()
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