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Nearly 44 million American men and women suffer from osteoporosis, with osteoporotic fractures costing the U.S. $17 billion a year to treat. Osteoporosis Management A WAKE-UP CALL Osteoporosis, or low bone mass, is a major health threat for people aged 50 and older. Osteoporotic fractures, especially hip fractures, are major causes of morbidity and mortality among the elderly population, and half of hip fracture patients never return to their former state of ambulation. Further, between 12% to 20% of hip fracture patients die within a year of the fracture. Osteoporosis is a systemic bone disease characterized by low bone mass and microarchitectural deterioration of bone tissue, resulting in an increase in bone fragility and fractures. Although the only symptoms of osteoporosis are the fractures that appear with the advanced stages of the disease, patients and physicians have an interest in managing this silent disease before fractures occur. Early diagnosis and treatment along with regular monitoring are crucial to patients’ quality of life and life expectancy. Still, despite the availability of accessible diagnostic methods and treatment options, osteoporosis is massively under-diagnosed. “Given the economic and social costs of osteoporotic fractures, strategies to identify and manage osteoporosis in the primary care setting need to be established and implemented.” From: “Identification and Fracture Outcomes of Undiagnosed Low Bone Mineral Density in Postmenopausal Women: Results From the National Osteoporosis Risk Assessment,” Ethel S. Siris, MD, et. al., JAMA. 2001;286:2815-2822 Your Distributor Can Help You! • Product training and demonstrations • Information for product evaluation • Education Diagnosis of the Disease Treatment Options Any post-menopausal woman, anyone over 65, and any patient with a pre-existing medical condition or a lifestyle that may lead to osteoporosis should be assessed for osteoporosis risk. The physician’s treatment options for osteoporosis have expanded in recent years. For many years, hormone replacement therapy (HRT), originally prescribed for a number of menopause-related symptoms, was the treatment of choice for osteoporosis and the prevention of fractures. In recent years, drugs developed for this purpose, such as biphosphonates and Selective Estrogen Receptor Modulators (SERMs), have been introduced and many more are being researched. Users of these medications demonstrate a decrease in fracture rate. The diagnosis of the disease by the physician should be based on the patient’s medical history, osteoporosis risk assessment results, and the results of bone densitometry or bone sonometry tests. The patient’s medical history should be taken, with an emphasis on the risk factors for osteoporosis. Risk factors for osteoporosis include: • • • • • • • • A previous atraumatic fracture Family history of osteoporosis Body weight of 127 lbs. or less Early menopause (before age 45) Diet low in calcium and Vitamin D Inactive lifestyle Smoking Use of medications affecting bone (thyroid medications, Dilantin, cortisone/ prednisone, chemotherapy, or Heparin) A wide range of devices are used to assess fracture risk. These tests measure bone either at central (axial) skeletal sites such as the spine or hip, or at peripheral skeletal sites such as the forearm or heel. Technologies used to measure bone include radiation-based technologies and ultrasound-based technologies. Radiation-based Technologies Dual X-ray Absorptiometry (DXA) exams that measure bone mineral density (BMD) have been used to assess fracture risk since 1987. The devices are generally used to evaluate bone at the lumbar spine or the proximal femur, and cost $45,000 to $100,000. Other radiation-based technologies for diagnosis include quantitative computed tomography (QCT) and radiographs, but these are less common than DXA. Because of their cost, bulk, and the licensing requirement for operating X-ray based devices, these technologies are typically available at larger clinics and specialty providers. Radiation-based peripheral measurement methods are also available. These devices include peripheral DXA (pDXA), radiographic absorptiometry (RA), and peripheral quantitative computed tomography (pQCT) devices, and are typically priced between $10,000 to $25,000. These devices require radiology licensing for operation. The Physician’s Responsibility Aware of the serious consequences of osteoporosis, physicians should work to diagnose and treat osteoporosis before a fracture occurs. Physicians also may wish to educate patients about the disease and about what can be done to reduce fracture risk—even if the patient has already had a fracture. A recently published study found that nearly half of post-menopausal women in the United States have undiagnosed osteoporosis. In order to stem this epidemic, the researchers concluded that management of osteoporosis —from early diagnosis, to treatment, to regular monitoring—be moved to the primary care setting. With the personalized relationship of the primary care physician to the patient, along with new advanced and compact solutions for osteoporosis diagnosis, patients and their physicians can win the war against osteoporosis. Quantitative Ultrasound Quantitative ultrasound (QUS) devices evaluate bone by measuring different properties of an ultrasound wave emitted through or along bone. These systems differ from imaging ultrasound systems in that they analyze quantitative, measurable aspects of the ultrasound wave, such as how fast it travels, rather than an image produced by ultrasound. QUS devices may measure the bone at one skeletal site or at multiple skeletal sites for added measurement flexibility and fracture discrimination. Measurement results from QUS devices are affected by a number of bone characteristics, including bone mineral density, elasticity, cortical thickness, and the microarchitecture of the bone, all of which affect bone strength. QUS devices are radiation-free, compact, easy to operate, and do not require licensing for use. QUS devices are typically priced between $10,000 and $25,000. Sponsored by Sunlight Medical, manufacturer of Sunlight Omnisense ®, the only multi-site bone sonometer available worldwide. For reprints, visit www.HIDAnetwork.com or call (703) 549-4432 Copyright 2002: Health Industry Distributors Association