Osteoporosis

Fewer than 20% of patients presenting with minimal trauma fractures are investigated or treated for osteoporosis. 

 

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 Osteoporosis explained

Osteoporosis

Key points

  • Identify and treat patients with minimal trauma fracture. Many people who sustain a minimal trauma fracture are treated for the fracture and not the underlying osteoporosis.
  • Identify patients with other risk-factors for osteoporotic fracture. Consider factors in addition to bone mineral density (BMD) and age.
  • Discuss the risks and implications of osteoporotic fractures with these patients and approaches to reduce these risks.
  • Use bone densitometry and laboratory tests to assess severity of osteoporosis.
  • Medicines for osteoporosis vary markedly: consider effectiveness, tolerability, co-morbidities, and patient preferences when choosing therapy.
  • Poor adherence to osteoporosis treatment is a leading cause of fractures and hospitalisations. Review therapies regularly for adherence and treatment response.

 

MedicineWise News: Recognising those at risk


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Osteoporosis is under-recognised and undertreated, even in people who present with minimal trauma fractures.

Find out more about what clinical risk factors impact fracture risk, and how you can help patients minimise their risk of fracture.

 

Australian Prescriber: Bone mineral density: testing for osteoporosis


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Angela Sheu and Terry Diamond
Aust Prescr 2016;39:35-91 Apr 2016

A thoracolumbar X-ray is useful in identifying vertebral fractures, and dual energy X-ray absorptiometry is the preferred method of calculating bone mineral density.

Read the full article

 

Background feature: Why osteoporosis matters


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General practice can play an important role in preventing the health burden associated with osteoporosis through timely diagnosis and management to prevent osteoporotic fractures.

Find out why osteoporosis matters and what we need to do to address gaps in practice.

 

Osteoporosis in aged care


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Osteoporosis is increasingly prevalent in an aging population and may affect a large proportion of aged care residents. Bone health assessment, falls prevention measures and regular medicine review can go a long way towards avoiding the pain, disability and mortality caused by fractures.

Get the detailed practice points for osteoporosis treatment in aged care.

 

Osteoporosis is not just a women's disease


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In men, minimal trauma fractures due to osteoporosis result in higher mortality rates compared with women. Despite this, treatment uptake in men is low, with 90% of men eligible for osteoporosis medicines remaining untreated.

Find out more about risk factors for osteoporosis in men.

 

Optimising treatment for osteoporosis


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Once osteoporosis is confirmed, it should be treated appropriately, to maximise benefit and minimise side effects and other risks.

Review the evidence for best practice treatment of osteoporosis

 

Evaluation: GP survey results for Osteoporosis program

We surveyed GPs who participated in the visiting program 'Preventing fractures: where to start with osteoporosis' to find out what they learned and whether they thought it was worthwhile.

Find out what our respondents had to say.

 

CPD

Consolidate your knowledge about osteoporosis, brush up on current guidelines and practices and earn CPD points through our learning activities.

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Research summary

Clinical guidelines

Guidelines Results / Recommendations
Royal Australian College of General Practitioners. Clinical guideline for the prevention and treatment of osteoporosis in postmenopausal women and older men. Melbourne: RACGP, 2010Clinical guideline for the prevention and treatment of osteoporosis in postmenopausal women and older men.This guideline reviews the pharmacological management of osteoporosis to May 2009. Check the RACGP website for any reviews or updates of this guideline.
Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 9th ed. East Melbourne, Vic: RACGP, 2016.
General practice guidance on preventive care. It includes primary and secondary (early detection and intervention) prevention activities for osteoporosis.
Osteoporosis Australia. Building healthy bones throughout life: An evidence-informed strategy to prevent osteoporosis in Australia. MJA Open 2013 2, Suppl 1
An evidence-informed strategy to prevent osteoporosis in Australia, including age-based recommendations for calcium, vitamin D and exercise and information on falls prevention. 
SIGN. Guideline No. 142: Management of osteoporosis and the prevention of fragility. Edinburgh: SIGN, 2015

This evidence-based guideline on the management of osteoporosis and prevention of fractures.

It covers risk factors for fracture, tools for assessment of fracture risk, pharmacological, and non-pharmacological treatments, treatment of painful vertebral fractures and systems of care. 

Expert Group for Endocrinology. Endocrinology guidelines: version 5(2). Melbourne: Therapeutic Guidelines Ltd, 2014. [eTG Online]
The most current and comprehensive of the Australian guidelines on osteoporosis, covering diagnosis, risk factors, prevention and treatment. 

Fracture risk assessment

Reference Results / Recommendations
Kanis JA, Johnell O, Oden A, et al. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 2008;19:385-97Describes development of a fracture risk assessment tool (FRAX) to predict 10-year fracture risk in men and women, based on clinical risk factors with or without BMD measurement.

The clinical risk factors, identified from previous meta-analyses comprised BMI, prior history of fracture, parental history of hip fracture, use of oral glucocorticoids, rheumatoid arthritis, current smoking and alcohol intake ≥ 3 daily

Fracture, refracture and mortality

Reference Results / Recommendations
Bliuc D, Nguyen ND, Nguyen TV, et al. Compound risk of high mortality following osteoporotic fracture and re-fracture in elderly women and men. J Bone Miner Res 2013Study of the long-term cumulative incidence of subsequent fracture and total mortality in community dwelling participants aged 60+ years from the Dubbo Osteoporosis Epidemiology Study. It found:
  • Risk of death is elevated for 10 years following an initial fracture, but greatest in the first 5 years. 
  •  In the first 5 years post-fracture, approximately 26% or women and 37% of men died. 
  • Refracture is associated with a further increase in mortality – 50% of women and 75% of men who experienced a refracture within 5 years died. 
  • Total 5-year mortality rate (death following fracture or refracture) was 39% in women and 51% in men.

Medication and adherence

Reference Results / Recommendations
Australian Institute of Health and Welfare. Use of antiresorptive agents for osteoporosis management. Canberra: AIHW, 2011A report on the supply pattern of antiresorptive agents (primarily alendronate and risedronate) for management of osteoporosis in Australia during 2003–07. This found:
  • Most people were prescribed antiresorptives by their GP. 
  • During the first 12 months of therapy, one quarter of patients stopped receiving antiresorptives by 6 months; 1 in 10 only receiving the first supply. 
  • There appears a clear need to monitor the use of antiresorptive therapy, particularly in the early months of treatment, to encourage adherence and the associated health benefits.