PREDICTION FRACTURE RISK .1. BONE-DENSITY

Low bone mass is the most important and individually objective predict or of osteoporotic fragility fracture risk. The challenge to the clini cians who care for patients with low bone mass is to identify those wh o are asymptomatic and nonfractured by using a bone mass measurement t echnique to make a diagnosis and decide on the level of intervention. All bone mass measurement techniques have value and limitations, neces sitating careful individual clinical interpretation to avoid a misdiag nosis of osteoporosis or an erroneous interpretation of serial changes in bone mass. The inverse relationship between low bone mass and incr easing fracture risk needs to be carefully interpreted because this re lationship has only been determined in patients with a mean age of 65 years. It is not the same in younger, perimenopausal patients. Increas ing age is a strong, independent risk factor for fragility fracture. I n patients older than 70 years the curves relating fracture risk to lo w bone mass density become exponential when more than 3.0 standard dev iations below peak adult bone mass, The assessment of this relationshi p is a professional activity and needs clinical input from appropriate ly educated physicians.