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21 October, 2019 00:00 00 AM

WHO criteria for diagnosis of osteoporosis

WHO criteria for diagnosis of osteoporosis

Under the auspices of the World Health Organization (WHO), a panel of experts has periodically met on the topic of assessment of fracture risk and osteoporosis.


The World Health Organization first convened a group of experts in 1994 to assess fracture risk and its application to screening for postmenopausal osteoporosis.  The scientific group defined osteoporosis based on bone mineral density (BMD). A standardized score, called T-score, comparing BMD to average values for young healthy women is used to define the categories.

The categories for diagnosis are:

normal (T-score -1.0 and above)

low bone mass, referred to as osteopenia (T-score between -1.0 and -2.5)

osteoporosis (T-score -2.5 and below)

severe osteoporosis (T-score -2.5 and below with history of a fracture)

These criterion applied only to white postmenopausal women since the research data was primarily limited to this group. In addition, diagnosis could only be based on three skeletal sites of measurement: lumbar spine, hip, or forearm.


Advances in research demonstrated limitations in the original definition. Defining fracture risk by BMD alone did not capture the majority of people at risk for breaking a bone. In addition, studies of men and nonwhite women provided estimates of fracture risk in these populations.

In 2004, another scientific group met to reevaluate the assessment of osteoporosis. After rigorous scientific study and debate, a revised description of osteopenia and assessment of osteoporosis was released in 2008.

The revised assessment includes BMD with selected risk factors for fracture along with height and weight. A fracture risk score, called FRAX, is calculated to determine your 10-year probability of fracture. Two scores are given: probability of hip fracture and the other for a major osteoporotic fracture, defined as wrist, shoulder, hip, or painful spine fractures.

Intervention criteria

Countries have set different criteria for when treatment with osteoporosis medicines is recommended. In the United States, the National Osteoporosis Foundation (NOF) released new guidelines at the same time as WHO-2. Treatment guidelines were established based on fracture risk and a cost-effective model for lowering risk with use of osteoporosis medicines. The guidelines for treatment are for postmenopausal women of any race or ethnicity and men age 50 and over.

Three major categories are defined as high-risk groups that should consider treatment with FDA-approved medicines to lower their risk:

1. History of fracture of the hip or spine

2. Bone mineral density in the osteoporosis range (T-score of -2.5 or lower)

3. Bone mineral density in the low bone mass or osteopenia range with a higher risk of fracture defined by FRAX score for

a. Major osteoporotic fracture 10-year probability of 20% or higher or

b. Hip fracture 10-year probability 3% or higher


X-rays are unable to quantitate bone mineral density. It takes about 30% bone loss before a standard x-ray is able to detect low bone density. Therefore, x-rays are not used to assess bone density and risk of fracture.

However, x-rays are used to diagnose broken bones. When a fracture is suspected but not obvious such as a stress fracture, further testing with a bone scan using nuclear medicine or an MRI may be ordered.

Modify to avoid loading the spine

If you have low bone density in the spine, you should avoid any exercises or positions that increase loads on the spine. These would include positions that involve bending forward from the waist. Instead you should try to maintain a neutral spine. Work with an experienced instructor to learn necessary modifications to various poses.

If you are already participating in yoga and have recently been diagnosed with osteoporosis, you should reevaluate your current regimen.


All standing postures basically work on your balance since you are engaging core strength as you are holding poses.  If you have difficulty with your balance and or just in any type of poses your yoga instructor can to modify the pose or offer props (chairs, blocks, walls, pillows, straps) to help you.

Don’t shy away from these type of physical activities if you have of a diagnosis of osteoporosis. Seek out experienced instructors who know about osteoporosis who will help you safely do yoga or modify your regimen if you are already practicing yoga. Most of all participate in activities that you enjoy and find rewards from.


Yogurt is a milk product that is an excellent source of calcium. Even if you are lactose intolerant, yogurt may be a choice for a calcium-rich food. Yogurt contains active and live cultures of bacteria that aid in the digestion of lactose.

How much calcium is in yogurt?

The amount of calcium in yogurt is quite variable. You need to check the nutrition label of each product.  You can get more calcium from yogurt than a glass of milk, if you choose the right variety.

For example, nonfat plain yogurt may contain 45% calcium or 450 milligrams per 8-ounce serving. An 8-ounce glass of milk has 300 milligrams.

Nonfat plain yogurt has more than double the amount of calcium in nonfat plain Greek yogurt. Greek yogurt has more protein and as a result contains less calcium per serving. Flavored yogurt also has less calcium per serving than the plain variety. If you don’t like plain yogurt, try adding your own fruit, nuts, and honey to plain yogurt for more calcium and fewer carbohydrates.

Milligrams per 8-ounce serving

General examples of calcium content in yogurt:

Nonfat, plain 400-450 mg.

Nonfat, plain Greek 200 mg.

Low fat, flavored 200-250 mg.

Plain goat milk 200 mg.


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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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