[Epidemiology of bone and joint disease - the present and future - . The present situation and problems associated with medical screening systems for osteoporosis]

The current low osteoporosis treatment rate (20%) in Japan is problematic. Osteoporosis screening is needed to ensure that asymptomatic osteoporosis patients are identified and treated. However, five problems are associated with osteoporosis screening in Japan. First, among 1,783 district municipalities, osteoporosis screening was performed in only 1,062 municipalities in 2011. The performance rate is approximately 60% every year. Often, screening was not performed because of financial reasons. Second, the screening participation rates are low and vary among districts (0 - 15%). Third, the bone mineral density measuring apparatus is not sufficiently and widely available for osteoporosis screening. Fourth, the screening results are mainly determined from bone mineral densities; therefore, fracture risk factors besides bone mineral density are not sufficiently reflected in the results. Finally, the screening interval is 5 years, which appears to be excessively longer than the interval of cancer screening. The Fracture Risk Assessment Tool (FRAX(®)) and locomotion check are useful methods for solving these problems. The addition of these two tools to the specific health check-ups increased the participation of patients from Asahi-machi compared with that previously observed ; the use of these tools was inexpensive. Furthermore, education and enlightenment regarding osteoporosis are important to increase the osteoporosis medical treatment rate and to spread awareness regarding osteoporosis screening through osteoporosis liaison services.