Application of the National Osteoporosis Foundation Guidelines to postmenopausal women and men: the Framingham Osteoporosis Study
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We applied the 2008 National Osteoporosis Foundation (NOF) Guidelines to Framingham Osteoporosis Study participants and found nearly one half of Caucasian postmenopausal women and one sixth of men aged 50 years and older would be recommended for osteoporosis treatment. Given the high proportion of persons recommended for treatment, NOF Guidelines may need to be re-evaluated with respect to budget impact.
Little is known about the public health impact of the NOF Guidelines. Therefore, we determined the proportion of US Caucasians recommended for treatment of osteoporosis according to NOF Guidelines (2003 and 2008).
One thousand nine hundred and forty-six postmenopausal women and 1,681 men aged ≥50 years from the Framingham Study with information on bone mineral density (1987–2001) were included. Information on clinical predictors was used to estimate the 10-year probability of hip and major osteoporotic fracture by FRAX® (version 3.0).
Overall proportion of women meeting treatment criterion was less when the 2008 NOF Guidelines were applied (41.1%) compared with 2003 Guidelines (47.8%). The proportion of women aged <65 years meeting treatment criterion was much less when applying 2008 Guidelines (23.1% in 2003, 8.3% in 2008), whereas the proportion of women aged >75 years increased slightly (78.3% in 2003, 86.0% in 2008). Seventeen percent of men aged ≥50 years met treatment criterion (2.5% aged 50–64 years, 49.8% aged >75 years).
Nearly one half of Caucasian postmenopausal women and one sixth of men aged 50 years and older would be recommended for osteoporosis treatment according to 2008 NOF Guidelines. Given the high proportion of persons recommended for treatment, NOF Guidelines may need to be re-evaluated with respect to budget impact.
KeywordsFRAX® NOF guidelines Osteoporosis Treatment
This research was supported by a Hartford Geriatrics Research Outcomes Health Scholars Award and through support from NIAMS/NIA R01 AR/AG 41398, Framingham Heart Study, (NHLBI/NIH Contract #N01-HC-25195) and the Boston University School of Medicine.
Conflicts of interest Drs. Berry and Samelson: industry-sponsored grants; Drs. Cummings and Kiel: industry-sponsored grants, consulting fees, and honorarium; Dr. Kanis: consulting and grants for many pharmaceutical companies, venture capitalists, and several governmental and non-governmental agencies.
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