Screening For Osteoporosis
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Screening For Osteoporosis Systematic Review To Update The 2002 U S Preventive Services Task Force Recommendation
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Author : U. S. Department of Health and Human Services
language : en
Publisher: Createspace Independent Pub
Release Date : 2013-05-01
Screening For Osteoporosis Systematic Review To Update The 2002 U S Preventive Services Task Force Recommendation written by U. S. Department of Health and Human Services and has been published by Createspace Independent Pub this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013-05-01 with Medical categories.
Osteoporosis is a systemic skeletal condition characterized by low bone mass and microarchitectural deterioration of bone tissue that increases bone fragility and risk for fractures. Osteoporosis may occur without a known cause, or secondary to another condition. These include corticosteroid therapy, excessive alcohol use, primary or secondary hypogonadism, low calcium intake, vitamin D deficiency, smoking, antiepileptic drug use, thyrotoxicosis, primary hyperparathyroidism, chronic liver or kidney disease, rheumatoid arthritis, diabetes, human immunodeficiency virus, organ transplantation, multiple myeloma, and others. Osteoporosis is diagnosed in individuals on the basis of presence of a fragility fracture or by bone mass measurement criteria. A fragility fracture results from forces that would not normally cause a fracture, such as a hip or wrist fracture from falling from standing height or a vertebral compression fracture. Although specific fracture sites have been considered more characteristic of osteoporosis, fractures occurring at nearly every anatomical site have been associated with osteoporosis. This systematic evidence review is an update for the U.S. Preventive Services Task Force (USPSTF) recommendation on screening for osteoporosis. In 2002, based on results of a previous review, the USPSTF recommended bone density screening for women age greater than or equal to 65 years and women age 60–64 years at increased risk for osteoporotic fractures. They made no recommendations for or against screening postmenopausal women age less than 60 years or women age 60–64 years without increased risk. Men were not considered in the prior recommendation. This update focuses on new studies and evidence gaps that were unresolved at the time of the 2002 recommendation. These include the effectiveness and harms of osteoporosis screening in reducing fractures and fracture-related health outcomes for men as well as postmenopausal women without known previous fractures; the performance of risk-assessment instruments and bone measurement tests in identifying individuals with osteoporosis; optimal screening intervals; and efficacy and harms of medications to reduce primary fractures in a screening-detected population. Based on evidence gaps identified from the previous review and using the methods of the USPSTF, the USPSTF and Agency for Healthcare Research and Quality (AHRQ) developed Key Questions for this review. Investigators created an analytic framework incorporating the Key Questions and outlining the patient populations, interventions, outcomes, and harms of the screening process. The target populations include postmenopausal women and men age greater than 50 years without known previous osteoporosis-related fragility fractures or secondary causes of osteoporosis. Key Questions include: 1. Does screening for osteoporosis and low bone density reduce osteoporosis-related fractures and/or fracture-related morbidity and mortality in the target populations? These include postmenopausal women (age less than 60 years, 60–64 years at increased risk for osteoporotic fractures, 60–64 years not at increased risk for osteoporotic fractures, and greater than or equal to65 years) and men less than 50 years. 2. What valid and reliable risk-assessment instruments stratify women and men into risk categories for osteoporosis or fractures? 3. A. How well does DXA predict fractures in men? B. How well do peripheral bone measurement tests predict fractures? C. What is the evidence to determine screening intervals for osteoporosis and low bone density? 4. What are the harms associated with osteoporosis screening? 5. Do medications for osteoporosis and low bone density reduce osteoporosis-related fracture rates and/or fracture-related morbidity and mortality in the target populations? 6. What are the harms associated with medications for osteoporosis and low bone density?
Effectiveness And Costs Of Osteoporosis Screening And Hormone Replacement Therapy
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Author :
language : en
Publisher: DIANE Publishing
Release Date :
Effectiveness And Costs Of Osteoporosis Screening And Hormone Replacement Therapy written by and has been published by DIANE Publishing this book supported file pdf, txt, epub, kindle and other format this book has been release on with categories.
Screening For Osteoporosis
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Author :
language : en
Publisher:
Release Date : 2010
Screening For Osteoporosis written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2010 with Osteoporosis categories.
BACKGROUND: Osteoporosis and related fractures are common in older individuals and lead to premature mortality, loss of function and independence, reduced quality of life, and high costs. Despite its importance, osteoporosis is under detected in the United States. This review updates evidence since the 2002 U.S. Preventive Services Task Force recommendation on osteoporosis screening. PURPOSE: To determine the effectiveness and harms of osteoporosis screening in reducing fractures for men and postmenopausal women without known previous fractures; the performance of risk-assessment instruments and bone measurement tests in identifying persons with osteoporosis; optimal screening intervals; and efficacy and harms of medications to reduce primary fractures. DATA SOURCES: Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the 4th Quarter of 2009), MEDLINE (January 2001 to December 2009), reference lists, and Web of Science searches. STUDY SELECTION: Randomized, controlled trials of screening or medications with fracture outcomes published in English; performance studies of validated risk-assessment instruments; and systematic reviews and population-based studies of bone measurement tests or medication harms. DATA EXTRACTION: Data on patient populations, study design, analysis, follow-up, and results were abstracted; study quality was rated by using criteria developed by the USPSTF. DATA SYNTHESIS: Risk-assessment instruments are modest predictors of low bone density (area under the curve, 0.13 to 0.87; 14 instruments) and fractures (area under the curve, 0.48 to 0.89; 11 instruments); simple and complex instruments perform similarly. Dual-energy x-ray absorptiometry predicts fractures similarly for men and women; calcaneal quantitative ultrasonography also predicts fractures, but correlation with dual-energy x-ray absorptiometry is low. Repeating a bone density measurement up to 8 years after an initial measurement does not significantly improve predictive performance for fracture outcomes. For postmenopausal women, bisphosphonates, parathyroid hormone, raloxifene, and estrogen reduce primary vertebral fractures; bisphosphonates reduce primary nonvertebral fractures in sensitivity analysis. Medications are effective for bone density T-scores of 2.5 or less for women without previous known fractures. Primary prevention trials are lacking for men. Bisphosphonates are not consistently associated with serious adverse events; raloxifene and estrogen increase thromboembolic events; estrogen increases stroke; and estrogen with progestin increases coronary heart disease and breast cancer. LIMITATIONS: Trials of screening with fracture outcomes, screening intervals, and medications to reduce primary fractures, particularly enrolling men, are lacking. CONCLUSIONS: Although methods to identify risk for osteoporotic fractures are available and mediations to reduce fractures are effective, no trials directly evaluate screening effectiveness, harms, and intervals.
Screening Men For Osteoporosis
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Author : U. S. Department of Veterans Affairs
language : en
Publisher: Createspace Independent Pub
Release Date : 2013-06-18
Screening Men For Osteoporosis written by U. S. Department of Veterans Affairs and has been published by Createspace Independent Pub this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013-06-18 with Medical categories.
Although the Surgeon General's recent report on osteoporosis stated that, “Strong bones (are) essential to overall health and quality of life,” it warned that, “The bone health status of Americans… is in jeopardy.” Traditionally, osteoporosis was viewed as a disease of women, but it has become clear that osteoporotic fractures result in substantial morbidity, mortality, and costs in men. A 60-year old man has a 25% lifetime risk of sustaining an osteoporotic fracture. The consequences of this fracture can be severe as the one-year mortality rate in men after hip fracture is twice that of women. With the aging of the population, rates of osteoporosis in men are expected to increase nearly 50% in the next 15 years and hip fractures rates are projected to double or triple by 2040. Furthermore, annual U.S. direct medical costs for osteoporosis exceed $17 billion and are expected to increase rapidly with an aging population. The percentage of costs directly attributable to men or veterans is unclear, although 25% of hip fractures, the fracture type associated with greatest costs due to hospitalization and long-term care, occur in men. This large and growing clinical and cost burden, combined with an environment of increasingly limited health care resources, strongly underlies the need to develop rational, evidence-based osteoporosis management strategies to obtain maximum benefit for every health care dollar spent. Despite the substantial advances in our understanding of osteoporosis over the last decade, there are no consensus guidelines on the assessment and management of male osteoporosis. Although osteoporosis management strategies have been evaluated in women, much less work has been done in this area in men. Lack of research in this area has led to considerable uncertainty regarding optimal osteoporosis strategies in men and Veterans. The VA Office of Quality and Performance and the U.S. Preventive Services Task Force offer no clinical practice guidelines on the management of osteoporosis in men. This review is being performed as part of the Evidence Synthesis Project, an HSR&D-organized initiative to provide VA policymakers with high quality evidence reviews. The purpose of this review is to analyze the literature in order to answer three key questions: 1) What is the epidemiology and what are the key risk factors for male osteoporosis?; 2) Are there any validated screening tools for osteoporosis in men (beyond DXA-assessed central bone density)?; and 3) What is the evidence regarding bone mineral density and fracture risk? Although 25% of men over the age of 60 will sustain osteoporotic fractures during their lifetime, data suggest that male osteoporosis is underdiganosed and undertreated. In order to help inform decisions about whether the Veterans Health Administration should develop screening guidelines for male osteoporosis, summaries of what is known about 1) the epidemiology of male osteoporosis, and 2) the validity of tools to screen and diagnose male osteoporosis are needed. The Key Questions were: Key Question 1. What are the prevalence of and risk factors for osteopenia, osteoporosis and osteoporotic fractures among men in general and among male Veterans specifically? Key Question 2. Are there any validated tools (outside of central bone density) to screen for osteoporosis in men? Key Question 3. What values of BMD determined by Dual energy X-ray Absorptiometry (DXA) (and by different DXA techniques) have been used to diagnose osteopenia and osteoporosis; and what is the evidence regarding the relationship between differing definitions and the development of osteoporotic fractures?
Osteoporosis In Men
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Author : Eric S. Orwoll
language : en
Publisher: Academic Press
Release Date : 2009-11-30
Osteoporosis In Men written by Eric S. Orwoll and has been published by Academic Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2009-11-30 with Medical categories.
Since the publication of the first edition, the U.S. Surgeon General released the first-ever report on bone health and osteoporosis in October 2004. This report focuses even more attention on the devastating impact osteoporosis has on millions of lives. According to the National Osteoporosis Foundation, 2 million American men have osteoporosis, and another 12 million are at risk for this disease. Yet despite the large number of men affected, the lack of awareness by doctors and their patients puts men at a higher risk that the condition may go undiagnosed and untreated. It is estimated that one-fifth to one-third of all hip fractures occur in men. This second edition brings on board John Bilezikian and Dirk Vanderschueren as editors with Eric Orwoll. The table of contents is more than doubling with 58 planned chapters. The format is larger – 8.5 x 11. This edition of Osteoporosis in Men brings together even more eminent investigators and clinicians to interpret developments in this growing field, and describe state-of-the-art research as well as practical approaches to diagnosis, prevention and therapy. Brings together more eminent investigators and clinicians to interpret developments in this growing field Describes state-of-the-art research as well as practical approaches to diagnosis, prevention and therapy There is no book on the market that covers osteoporosis in men as comprehensively as this book
Screening Men For Osteoporosis
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Author :
language : en
Publisher:
Release Date : 2007
Screening Men For Osteoporosis written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2007 with Men categories.
BACKGROUND: Although 25% of men over the age of 60 will sustain osteoporotic fractures during their lifetime, data suggest that male osteoporosis is underdiganosed [sic] and undertreated. In order to help inform decisions about whether the Veterans Health Administration should develop screening guidelines for male osteoporosis, summaries of what is known about (1) the epidemiology of male osteoporosis, and (2) the validity of tools to screen and diagnose male osteoporosis are needed. The Key Questions were: Key Question 1. What are the prevalence of and risk factors for osteopenia, osteoporosis and osteoporotic fractures among men in general and among male Veterans specifically? Key Question 2. Are there any validated tools (outside of central bone density) to screen for osteoporosis in men? Key Question 3. What values of BMD determined by Dual energy X-ray Absorptiometry (DXA) (and by different DXA techniques) have been used to diagnose osteopenia and osteoporosis; and what is the evidence regarding the relationship between differing definitions and the development of osteoporotic fractures? METHODS: We searched PubMed from 1990-2006 using standard search terms. Titles, abstracts, and articles were reviewed in duplicate by physicians trained in the critical analysis of literature. Data were extracted by quantitative analysts. Pooled analyses were performed for the comparison of either calcaneal ultrasound or the Osteoporosis Screening Tool compared to central DXA; all other data were narratively summarized. RESULTS: We screened 564 titles and performed a more detailed review on 378 articles. From this, we identified 173 articles that addressed risk factors for osteoporosis, 27 articles that addressed diagnostic tools, and 31 articles about differing DXA levels and fracture risk. We identified an older high quality meta-analysis of risk factors for osteoporosis. Of the risk factors assessed in this review that the authors classified as something other than high risk, VA policymakers selected alcohol use, diabetes mellitus type II, and spinal cord injury as the factors for assessment in this review.
Assessment Of Fracture Risk And Its Application To Screening For Postmenopausal Osteoporosis
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Author : WHO Study Group on Assessment of Fracture Risk and its Application to Screening for Postmenopausal Osteoporosis
language : en
Publisher:
Release Date : 1994
Assessment Of Fracture Risk And Its Application To Screening For Postmenopausal Osteoporosis written by WHO Study Group on Assessment of Fracture Risk and its Application to Screening for Postmenopausal Osteoporosis and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 1994 with Medical categories.
Screening Men For Osteoporosis
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Author :
language : en
Publisher:
Release Date : 2007
Screening Men For Osteoporosis written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2007 with Men categories.
Effectiveness And Costs Of Osteoporosis Screening And Hormone Replacement Therapy Cost Effectiveness Analysis
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Author :
language : en
Publisher:
Release Date : 1995
Effectiveness And Costs Of Osteoporosis Screening And Hormone Replacement Therapy Cost Effectiveness Analysis written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 1995 with Medical screening categories.
Osteoporosis
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Author : Robert A. Adler
language : en
Publisher: Springer Science & Business Media
Release Date : 2009-12-14
Osteoporosis written by Robert A. Adler and has been published by Springer Science & Business Media this book supported file pdf, txt, epub, kindle and other format this book has been release on 2009-12-14 with Medical categories.
Osteoporosis is a widespread disorder with significant worldwide health and economic impact. In the second edition of the highly successful Osteoporosis: Pathophysiology and Clinical Management, new editor Robert A. Adler, MD, uses the same approach as the first edition, pairing a chapter on the basic science of a disorder followed by a chapter on its clinical aspects. Updated and expanded, this second edition includes many new chapters reflecting the growing literature on osteoporosis. New topics cover such areas as methods of bone imaging, screening for osteoporosis, adherence to therapy, and even a novel and exciting chapter on osteoporosis in men, to name just several. In Osteoporosis: Pathophysiology and Clinical Management, Second Edition, leading experts in a variety of fields have once again provided a wealth of invaluable, state-of-the-art information to illuminate the major scientific and clinical aspects of osteoporosis.