Osteoporosis is common. In the 2011–12 Australian Health Survey, among community-dwelling adults aged > 50, 15% of women and 3% of men reported that they had been diagnosed with osteoporosis. As osteoporosis is frequently a ‘silent disease’, this probably represents an underestimate.1

Osteoporosis also imposes a considerable health burden. Osteoporosis Australia estimates there were 140,800 fractures among people with osteoporosis or osteopenia in 2012, with around 90,000 requiring hospitalisation.2 In just over one-third of people with osteoporosis, core activities are limited to some extent, with 15% experiencing severe or profound restrictions.3

Practice gaps in recognition and management

Unfortunately osteoporosis frequently goes unrecognised. Many patients presenting with minimal trauma fracture fail to undergo bone mineral density (BMD) testing or to receive adequate treatment for osteoporosis.4-9 Older men and people taking long-term corticosteroids are particularly likely to be missed.10-12 Therapeutic Guidelines described this as ‘one of the largest gaps in the practice of evidence-based medicine in Australia.13

Even after diagnosis, treatment for osteoporosis frequently remains suboptimal, with poor adherence a major reason for inadequate treatment response.13,14 PBS data suggests that 40% of people prescribed a medicine for osteoporosis do not take their medication as directed.15 

A primary care opportunity

General practice can play an important role in preventing the health burden associated with osteoporosis, with the majority of medicines for osteoporosis initiated by GPs.15 As the population ages, the importance of evidence-based osteoporosis prevention and management will only increase.

More needs to be done. While osteoporosis is incurable, we can reduce the disease burden through timely diagnosis and management to prevent osteoporotic fractures. Adequate dietary calcium, vitamin D and regular moderate exercise are important factors for osteoporosis prevention and maintaining bone health throughout life.16 

References

  1. Australian Institute of Health and Welfare. Estimating the prevalence of osteoporosis in Australia. Canberra: AIHW, 2014. [Online] (accessed 17 August 2015).
  2. Osteoporosis Australia. Osteoporosis costing all Australians: A new burden of disease analysis – 2012 to 2022. Sydney: Osteoporosis Australia, 2013. [Online] (accessed 24 March 2015).
  3. Australian Institute of Health and Welfare. A snapshot of osteoporosis in Australia 2011. Canberra: AIHW, 2011.
  4. Diamond T, Lindenberg M. Osteoporosis detection in the community. Are patients adequately managed? Aust Fam Physician 2002;31:751–2.
  5. Kelly AM, Clooney M, Kerr D, et al. When continuity of care breaks down: a systems failure in identification of osteoporosis risk in older patients treated for minimal trauma fractures. Med J Aust 2008;188:389–91.
  6. Kimber CM, Grimmer-Somers KA. Evaluation of current practice: compliance with osteoporosis clinical guidelines in an outpatient fracture clinic. Aust Health Rev 2008;32:34–43.
  7. Myers TA, Briffa NK. Secondary and tertiary prevention in the management of low-trauma fracture. Aust J Physiother 2003;49:25–9. [PubMed].
  8. National Institute of Clinical Studies. Evidence-Practice practice gaps report: volume 2. Melbourne: NICS, 2005. [Online] (accessed 7 July 2015).
  9. Smith J, Inderjeeth C, Lewin G. Osteoporosis risk in a home care setting. Australas J Ageing 2009;28:75–80. [Online].
  10. AIHW Australian GP Statistics and Classification Centre. Oral corticosteroid use and osteoporosis. Sydney: AGPSCC University of Sydney, 2009. [Online].
  11. Otmar R, Henry MJ, Kotowicz MA, et al. Patterns of treatment in Australian men following fracture. Osteoporos Int 2011;22:249–54. [PubMed].
  12. Otmar R, Reventlow SD, Nicholson GC, et al. General medical practitioners' knowledge and beliefs about osteoporosis and its investigation and management. Arch Osteoporos 2012;7:107–14. [PubMed].
  13. Expert Group for Endocrinology. Endocrinology guidelines: version 5(2). Melbourne: Therapeutic Guidelines Ltd, 2014. [eTG Online] (accessed 17 July 2014).
  14. Royal Australian College of General Practitioners. Clinical guideline for the prevention and treatment of osteoporosis in postmenopausal women and older men. Melbourne: RACGP, 2010. [Online].
  15. Australian Institute of Health and Welfare. Use of antiresorptive agents for osteoporosis management. Canberra: AIHW, 2011. [Online].
  16. Osteoporosis Australia. Building healthy bones throughout life: an evidence-informed strategy to prevent osteoporosis in Australia. MJA Open 2013: 2 (Supp 1). [Online].