Iqbal, Romaina

Jafri, Lena

Khan, Aysha Habib

English

eCommons@AKU

eCommons@AKUCommunity Health Sciences Department of Community Health SciencesJanuary 2016Critical Need of Osteoporosis Risk AssessmentTool for PakistanLena JafriAga Khan University, lena.jafri@aku.eduRomaina IqbalAga Khan University, romaina.iqbal@aku.eduAysha Habib KhanAga Khan University, aysha.habib@aku.eduFollow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_chs_chsPart of the Osteopathic Medicine and Osteopathy CommonsRecommended CitationJafri, L., Iqbal, R., Khan, A. H. (2016). Critical Need of Osteoporosis Risk Assessment Tool for Pakistan. Journal of the College ofPhysicians and Surgeons Pakistan, 26(1), 80.Available at: https://ecommons.aku.edu/pakistan_fhs_mc_chs_chs/42180 Journal of the College of Physicians and Surgeons Pakistan 2016, Vol. 26 (1): 80Sir,Osteoporosis is an ignored non-communicable diseasewhich needs attention in this part of the world as itaffects 1 in 3 women over the age of 50 worldwide.There is an extreme lack of solid epidemiologicaldata on osteoporosis in Pakistan and its diagnosticfacilities are meagre. However, several studies havebeen performed for the assessment of risk factors,locally.1,2There is generally a low level of osteoporosis awarenessin the country due to low level of education, infrequentcontact with the health service, large family size, andpoor economic conditions. Osteoporosis may remainunnoticed for many years until a fracture occurs. In theabsence of fracture, osteoporosis is diagnosed bymeasuring Bone Mineral Density (BMD) using DualEnergy X-ray Absorptiometry (DXA). There are limitednumber of DXA machines in Pakistan and available onlyin urban areas, which are not affordable by most. Formany years BMD measurements have provided thecustomary method of assessing the risk of fracture,based on the World Health Organization (WHO)classification of osteoporosis as bone mineral density2.5 standard deviations or more below the BMD of ayoung individual. This approach identifies only a smallpercentage of those who will experience a fracture. Iftreatment is targeted only at such individuals, the totalimpact of intervention will not be as efficient.Assessment of fracture risk can be improved by the useof clinical risk factors which act independently of BMD toincrease the risk of fracture.The introduction of the WHO fracture risk-assessmentcalculator (FRAX) in 2008 has facilitated the assess-ment of fracture risk on the basis of fracture probability.FRAX integrates the influence of well validated riskfactors for fracture from large prospective observationalstudies of men and women of different ethnicities andfrom different world regions (excluding Pakistan).There are several other osteoporosis screening instru-ments developed worldwide, like SCORE, ABONE,pBW, OSIRIS, SOFSURF, OSTA, NOF, WO-E andORAI.3 Most of these are based on non-Asianpopulation and unfortunately no such tool is available forPakistan where the risk factors are different from theCaucasians. For instance, standard Muslim norm ofPakistan is that alcohol consumption and tobacco usageare uncommon, especially among females, and isconsidered a taboo in our society. Thus, osteoporosisscreening questionnaires have so far not been validatedin Pakistani community.4,5 Similar tool is the need of timefor our society where factors like poverty, multiparity, lowcalcium intake, vitamin D deficiency, and lack of physicalactivity are prevalent.REFERENCES1. Lowe NM, Ellahi B, Bano Q, Bangash SA, Mitra SR, Zaman M.Dietary calcium intake, vitamin D status, and bone health inpostmenopausal women in rural Pakistan. J Health Popul Nutr2011; 29:465-70.2. Lateef M, Baig M, Azhar A. Estimation of serum osteocalcinand telopeptide-C in postmenopausal osteoporotic females.Osteoporos Int 2010; 21:751-5.3. Schwartz EN, Steinberg DM. Pre-screening tools to determinewho needs DXA. Curr Osteoporos Rep 2006; 4:148-52.4. Jaleel RNF, Khan A. Osteopenia in the younger females.J Surg Pak (International) 2010; 15:29-33.5. Ejaz SMA, Qureshi MA, Ali M. Prevalence of osteoporosis andosteopenia among Pakistani pre- and post-menopausalwomen. J Dent Med Sci 2012; 2:12-7.LETTER TO THE EDITORCritical Need of OsteoporosisRisk Assessment Tool forPakistanLena Jafri1, Romaina Iqbal2 and Aysha Habib Khan1Department of Pathology and Laboratory Medicine1 / CommunityHealth Sciences2, The Aga Khan University, Karachi.Correspondence: Dr. Aysha Habib Khan, Associate Professorand Section Head, Chemical Pathology, Department of Pathologyand Laboratory Medicine, The Aga Khan University, StadiumRoad, P.O. Box 3500, Karachi-74800.E-mail: aysha.habib@aku.eduReceived: May 29, 2015;   Accepted: October 12, 2015.

Critical Need of Osteoporosis Risk Assessment Tool for Pakistan

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Critical Need of Osteoporosis Risk Assessment Tool for Pakistan

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