Cost-effective osteoporosis intervention thresholds for Hong Kong postmenopausal women.

Osteoporosis is characterised by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture.1 Osteoporosis is more common in older people, and complications of fragility fractures are associated with high morbidity and mortality. Although there was a slight decline in the age-specific incidence of hip fracture from 1995 to 2004 in Hong Kong, the absolute number of hip fractures has increased due to an ageing population.2 In 1996, the cost of acute hospital care for hip fractures exceeded 1% of the public hospital budget. Sensitive fracture risk assessment tools can improve the prognostication of osteoporotic fracture and result in significant health care savings. The intervention threshold for osteoporosis should be based on the absolute risk rather than the relative risk of fracture based solely on the bone mineral density (BMD) T-score. Apart from BMD assessment, global evaluation of osteoporotic fracture risk can be enhanced by incorporation of clinical risk factor (CRF) assessment. We have identified eight independent CRFs for osteoporotic fracture in Hong Kong postmenopausal women. Some are related to the risk of fall; others are related to osteoporosis and low BMD.3 The World Hong Kong Med J 2015;21(Suppl 6):S13-6 HHSRF project number: 07080711 AWC Kung *, SM McGhee, SWY Tsang, J So, J Chau