Osteoporosis guidelines

Clients with osteoporosis or thin bones (oestopaenia), are at risk of fractures. These can be prevented by taking adequate calcium and vitamin D (possibly as tablets) and other bone strengthening drugs, usually biphosphonates.

Risk factors for osteoporosis

Previous fragility fracture
Prolonged corticosteroid therapy
Hysterectomy, premature menopause or history of amenorrhea (not treated to reduce risk of osteoporosis)
Risk factors e.g. liver or thyroid disease, malabsorption, alcoholism, rheumatoid arthritis and male hypogonadism
Family history of osteoporosis (including maternal hip fracture)
Low body mass < 19kg/m²
Smoking

(National Service Framework for Older People, Department of Health, 2001)

Assessment of oestoporosis

Previous fragility fracture (hip, arm or back fracture caused by a simple fall)
Radiographic evidence of vertebral fracture and/or loss of height associated with vertebral fracture (x-ray)
DEXA (Dual Energy X-ray Absorptiometer) bone mineral scan
FRAX Score (predicts future fracture risk): www.shef.ac.uk/FRAX/tool.jsp

(National Service Framework for Older People, Department of Health, 2001)

Osteoporosis management

All fallers over 65 at risk of osteoporosis should receive calcium and vitamin D (calcium 1200 mg/cholecalciferol 800 U daily).

Management fractured neck of femur

Clients should receive a bisphosphonate or other anti-resorptive treatment (unless clinically contraindicated or inappropriate) without the need for DEXA scanning.

Management fallers 65 to 75 years

For those with one of the following risk factors, consider performing a DEXA scan to guide treatment with anti-resorptive treatment:

Previous fragility fracture
Height loss more than 2 inches
Steroid use = 5mg prednisolone daily for one year in the last 10 years
BMI < 19

Fallers over 75 years

Clients with one or more of the following risk factors for osteoporosis should be considered for anti-resorptive treatment without the need for DEXA scanning

Previous fragility fracture
Steroid use = 5mg /day prednisolone for 1 year in the last 10 years

Guidance

‘The National Osteoporosis Guideline Group (NOGG)| was established to provide a clinical guideline for the management of men and women at high fracture risk’