World Osteoporosis Day 20 Oct 2017
World Osteoporosis Day (WOD) is dedicated to raising global awareness amongst healthcare professionals and the public of the prevention, diagnosis and treatment of osteoporosis and musculoskeletal disease.
Which patients are at risk?
- Age more than 65
- Previous non-violent fracture
- Immediate family member with osteoporosis, parental history of hip fracture
- Smoking
- Alcohol intake >2 standard drinks/day
- Lack of exercise
- Diet poor in calcium or vitamin D
- Glucocorticoid use
- Rheumatoid arthritis
- Secondary osteoporosis (eg, hypogonadism or premature menopause before 45 years old, malabsorption, chronic liver disease, inflammatory bowel disease)
Ask your patients to assess their risk of Osteoporosis by trying the 1-minute Osteoporosis test here.
Diagnosis of Osteoporosis
Osteoporosis is characterised by low bone mass, microarchitectural disruption and increased skeletal fragility. The World Health Organization (WHO) has defined osteoporosis based upon bone mineral density (BMD) using dual-energy x-ray absorptiometry (DEXA) measurements.
Hip BMD score:
Normal T-score of >-1
Osteopenia T-score <-1 and >-2.5
Osteoporosis T-score of <=-2.5
Severe osteoporosis T-score of <-2.5 and presence of at least one fragility fracture
Use the FRAX calculator to assess your patient’s risk for fractures here.
Treatment of Osteoporosis
Lifestyle Changes
- Calcium intake 1000mg/day and Vit D 800IU/day
- Exercise
- Avoid excessive alcohol and stop smoking
- Falls prevention
Who do we treat?
- History of fragility fracture
- BMD T score ≤ -2.5
- Osteopenia (T score -1.0 to -2.5) with high risk of fracture (FRAX 10-year probability of hip fracture or combined major osteoporotic fracture of ≥ 3 or ≥ 20 percent, respectively)
Pharmacologic Treatment Options
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Oral bisphosphonates
• Proven reduction in hip, vertebral and non-vertebral fractures
• Taken orally once per week
• Side effects: Upper GI symptoms, osteonecrosis of the jaw (ONJ), atypical femoral fractures (AFF)
• Contraindications: Active upper GI disorders, chronic kidney disease eGFR< 35ml/min
IV bisphosphonates
• Proven reduction in hip, vertebral and non-vertebral fractures
• IV infusion once per year
• Side effects: Flu-like symptoms, hypocalcemia, arthralgia, headache
• Contraindications: Chronic kidney disease eGFR< 35ml/min
SC denosumab
• Proven reduction in hip, vertebral and non-vertebral fractures
• SC injection once in 6 months
• Side effects: Cellulitis, increased infections, rash
SC teriparatide (parathyroid hormone)
• Proven reduction in vertebral and non-vertebral fractures
• SC injection daily for severe osteoporosis
• Side effects: Increased risk of osteosarcoma (in mice), hypercalcemia, renal
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