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Assessment of Fracture Risk and its Application to Screening for Postmenopausal Osteoporosis
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129 pages. Geneva: World Health Organization; 1994. $19.80.
Osteoporosis is increasingly recognized as a major public health problem; its estimated annual cost to the health care system in the United States is 7 to 10 billion dollars. Furthermore, because the population is aging, the scope of the problem is likely to increase exponentially, particularly in developing countries. Recognizing these trends, a World Health Organization Study Group was convened in Rome from 22 June to 25 June, 1992, to critically evaluate the methods available for assessing fracture risk and their suitability for use in screening for osteoporosis. This book summarizes the group's findings and recommendations.
A review of the epidemiology of osteoporosis is followed by a detailed discussion of the different techniques used to assess bone mass. Considerable attention is devoted to the sensitivity, specificity, and accuracy of the various techniques used to assess bone density. Assessment of rates of bone loss and the potential use of bone biochemical markers are briefly reviewed. Clinical assessment of risk and the shortcomings of this approach are also addressed and are followed by a discussion of hormonal and nonhormonal therapies for the treatment and prevention of osteoporosis. The report concludes with a detailed discussion of screening strategies.
The book succeeds in addressing the aims of the study group. Thus, the strengths of the book are its summary (with extensive references) of the epidemiology and costs of osteoporosis worldwide and its successful delineation of the strengths and weaknesses of the currently available methods for assessing bone mass and fracture risk. As such, this book will be most useful to those interested in understanding the public health aspects of this important problem; it is not to be used to learn about the pathogenesis of osteoporosis or the clinical management of the individual patient. It is primarily a guide for persons or groups involved in the development of screening strategies for osteoporosis.
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