关键词:
Osteoporosis
Risk factor
Elderly
FRAX
Screening
Comprehensive geriatric assessment
摘要:
The elderly at a risk of osteoporotic fractures are mainly detected clinically. Low-energy fractures due to fragility and age are the most important risk factor. A fall or a peripheral fracture in an old patient gives incentive to look for one or more vertebral fractures possibly associated. The twofold problem of public health relates to the seriousness of the hip fracture and to the high prevalence of osteoporosis in elderly population, which is often exposed to added fall risk. Screening for osteoporosis prior to a first fracture is still the ideal solution. Bone mineral density (BMD) may contribute to detection of osteoporosis and should be limited to the hipbone above 70 years (a score < -2.5 means an osteoporosis associated with fracture risk), but clinical risk factors must be assessed at the same time. The FRAX (Fracture Risk Assessment Tool) can contribute to establish, with caution, an individual fracture risk during a Standard Geriatric Assessment of the "frail" elderly patient;this should not be performed for "too sick" patients. Biologic results obtained at the beginning are an addition to the risk factors, which are essential to understand the BMD values, and enable to eliminate secondary osteoporosis cause. Measurement of vitamin D 2+3 level is part of this assessment, and it must absolutely be known and normalized, if necessary, prior to any therapeutic decision.