Osteopenia and osteoporosis are two conditions that affect bone health, leading to a decrease in bone density and an increased risk of fractures. These conditions have been a topic of much controversy and criticism in recent years, particularly with regards to the definitions and guidelines set by the World Health Organization (WHO) for their diagnosis and treatment. In this critical article, we will explore the criticisms of the WHO’s definitions of osteopenia and osteoporosis, and examine the evidence from peer-reviewed journals that support or refute these criticisms.
One of the main criticisms of the WHO’s definitions of osteopenia and osteoporosis is that they were arbitrary and not based on sound scientific evidence. Several studies have examined the validity of these definitions and their ability to predict fracture risk. A meta-analysis of 19 prospective studies by Kanis et al. (2002) found that the risk of fracture increased with decreasing BMD T-scores, but that the relative risk of fracture varied by age, sex, and other risk factors. This suggests that the use of a single BMD cutoff to define osteoporosis may not be appropriate for all patients.
Similarly, a study by Looker et al. (2010) found that the majority of fractures occurred in individuals with BMD T-scores above the WHO-defined osteoporosis threshold. This study suggests that the current definitions of osteoporosis may not identify all individuals at risk of fracture, and that other factors such as age, sex, and medical history should be considered in fracture risk assessment.
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