Clinical calcium
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Review
[Absolute risk for fracture and WHO guideline. WHO model for assessing absolute risk of fracture].
Goal for management of osteoporosis is prevention of fractures, although the diagnosis of osteoporosis is made according to bone mineral density (BMD) which plays a great role in monitoring the effectiveness of treatment. However, there are many countries and regions where BMD measurement is not available in primary health care. ⋯ A research group of the World Health Organization (WHO) has developed absolute risk assessment models for fracture incorporating several clinical risk factors with and without BMD. The present paper described the outline of these models and addressed several issues when applying these models to the primary medical care and preventive practice in Japan.
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The incidence of osteoporotic fractures increases along aging and the importance of their prevention is more emphasized in the elderly. Although the major determinants for fragile fractures in the elderly are not only the lower bone strength but also frailty and fall, treatments with anti-resorbers are effective also in the elderly. On the other hands, nutritional agents such as active vitamin D3 and vitamin K2 are effective in reducing the fracture incidences in spite of their modest effects on bone mineral density. Recently, the effects of vitamin Ds on the reduction of fall events are noticed and the prevention of osteoporotic fractures in the elderly through extra-skeletal mechanisms seems promising.
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Bone mineral density (BMD) is a strong predictor of osteoporotic fractures. However, the increase in fracture risk is not steep, rather gentle, for the decline in BMD values. ⋯ World Health Organization developed a fracture risk assessment tool, recommending its exploitation in the case findings. Under these circumstances, Japan guideline 2006 provided new criteria for the pharmacological intervention to prevent fragility fracture, besides the conventional criteria for diagnosing osteoporosis.
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Lumbar spinal stenosis is a major cause of low back and leg pain resulting in disability in elderly patients. There is now increasing number of patients who have lumbar spinal stenosis. ⋯ There are many treatment methods including conservative and surgical treatments for lumbar spinal stenosis. The improvement of the quality of life in the patient even if advanced ages can be expected by these treatments.