What is the significance of the World Health Organization's risk algorithm?
Ethel Siris, MD:
Sometime in 2007, or possibly in early 2008, the World Health Organization is going to release a new way of looking at who is at riskand this will be basically an algorithm that will be able to be utilized world wide.So this new World Health Organization algorithm will allow us to factor in the bone density, but also very importantly, the patient's age, as well as several other risk factors,such as whether you smoke, whether you take excess alcohol, whether you take steroids.These are all risk factors that will be asked about. Whether or not you already had a fracture, after about age 45 or 50 is a very important risk factorbecause if you had a previous fracture after the age of menopause, that’s a tremendous risk factor for another fracture.So things like that, whether either of your parents had a hip fracture, those kinds of things will be asked and when you have your bone density test and you come out of your bone density test,you will not only get your scores of what your bone density is, but you will get your 10 year fracture probability number. Now, what is that number going to mean?We will be able to say to a patient, this is your bone density score, this is your 10 year fracture probability. And your personal risk exceeds the level we consider to be acceptable,and for that reason, we would anticipate that your physician might wish to treat you with prescription medication beyond just giving you calcium and vitamin D sufficiency in order to lower your risk.So this will eliminate this whole confusion about Osteopenia. Osteopenia is not a disease. It's a risk factor and it will be applied in this way.And once you can do a better job identifying who is at risk, you can be much more rational and appropriate in recommending treatment.One of the unfortunate things in the United States today is that we really don't have a standard of care for when to treat, for when to diagnose, for when to evaluate.
Ethel Siris, MD continued...:
We don't have this standard of care yet.And the Surgeon General of the United States in a report issued in 2004 on bone health and osteoporosis made it very clear that we are not in good shape.One in two women and one in four men will fracture after age 50. That's bad.The second point he made is that we have the knowledge base to really do a good job helping to fix a good part of this.And the third point that he made was that we aren't applying that knowledge base.Now this WHO paradigm may help us to finally come a little closer to helping doctors sort out how to assess risk and what to do about it and that may insure that more people get evaluated.One group that we have neglected woefully, this is published in lots of papers, are the people who have already had a significant fracture.If you have a hip fracture today at age 78, in most parts of the country, you will go to the hospital, have it fixed very nicely, and nothing further will be done,even though that hip fracture is a flag, a red flag, that more fractures are likely as you age.Those patients do not get told about calcium, they don't get told about vitamin D, they don't get bone densities,and they typically don't get treated with one of the very effective drugs that will help reduce risk.They are the highest risk people, but for some reason, we aren't doing the right thing for them.Hopefully this new paradigm will spur that to happen, because those people, if they do a risk assessment, are going to have very high risk.