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Title: The impact of the new National Bone Health Alliance (NBHA) diagnostic criteria on the prevalence of osteoporosis in the USA

Author
item WRIGHT, NICOLE - University Of Alabama
item SAAG, KENNETH - University Of Alabama
item DAWSON-HUGHES, BESS - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item KHOSLA, SUNDEEP - Mayo Clinic
item SIRIS, ETHEL - Columbia University

Submitted to: Osteoporosis International
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/30/2016
Publication Date: 12/13/2016
Citation: Wright, N.C., Saag, K.G., Dawson-Hughes, B., Khosla, S., Siris, E.S. 2016. The impact of the new National Bone Health Alliance (NBHA) diagnostic criteria on the prevalence of osteoporosis in the USA. Osteoporosis International. doi: 10.1007/s00198-016-3865-3.

Interpretive Summary: The National Bone Health Alliance (NBHA,) a public-private partnership created in response to the U.S. Surgeon General's report on bone health and osteoporosis, recently assigned a working group of 17 clinicians and clinical scientists to consider the possibility of expanding the criteria for the clinical diagnosis of osteoporosis in the U.S. The NBHA position states that in postmenopausal women and in men aged 50 and older in the U.S., osteoporosis may be diagnosed based on any one of three elements: 1) traditional bone mineral density (BMD)-based criteria; 2) a low trauma fracture of the hip, spine, proximal arm, pelvis, and in some cases distal arm; or 3) a fracture risk score based on BMD and clinical risk factors that meets the widely used National Osteoporosis Foundation-recommended treatment intervention thresholds. This study was done to determine the impact of broadening the definition of osteoporosis. We utilized 2005-2008 data from the National Health and Nutrition Examination Survey (NHANES.) We estimated that 16.0% of men and 29.9% of women aged 50 years and older have osteoporosis. The expanded definition increases the prevalence of osteoporosis compared to BMD alone-based definitions, and it may better identify those at elevated fracture risk.

Technical Abstract: Summary: We evaluated the prevalence of osteoporosis using the osteoporosis diagnostic criteria developed by the National Bone Health Alliance (NBHA), which includes qualified fractures, FRAX score in addition to bone mineral density (BMD). The expanded definition increases the prevalence compared to BMD alone definitions; however, it may better identify those at elevated fracture risk. Purpose: The purpose of this paper is to estimate the prevalence of osteoporosis in US adults >/= 50 years using the NBHA osteoporosis diagnostic criteria. Methods: Utilizing 2005-2008 data of the National Health and Nutrition Examination Survey (NHANES), we identified participants with osteoporosis with any one of the following: (1) femoral neck or lumbar spine T-score -2.5 <-1.0; or (3) FRAX score at the National Osteoporosis Foundation intervention thresholds (>/= 3% for hip fracture or >/= 20% for major osteoporotic fracture). We estimated the prevalence overall and by gender and age. Results: Our sample included 1948 (54.3%) men and 1639 (45.7%) women. Approximately 12% were 80+ years and 21% were from racial/ethnic minority groups. We estimated that 16.0% (0.8) of men and 29.9% (1.0) of women 50+ years have osteoporosis. The prevalence increases with age to 46.3% in men and 77.1% in women 80+ years. The combination of FRAX score and fractures was the largest contributing factor defining osteoporosis in men (70-79, 88.1%; 80+, 80.1%), whereas T-score was the largest contributing factor in women (70-79, 49.2%; 80+, 43.5%). Conclusions: We found that 16% of men and 29.9% of women 50+ have osteoporosis based on the NBHA diagnostic criteria. Although the expanded definition increases the prevalence compared to BMD alone-based definitions, it may better identify those at elevated fracture risk in order to reduce the burden of fractures in older adults.