Medical management of men and women aged 45+ years who have or are at risk of osteoporosis Frail, increased fall risk +/- housebound Risk factorsPrevious fragility fracture Investigations Measure BMD [DXA, hip +/- spine] NORMAL T score above -1 OSTEOPENIA T score –1 to –2.5 OSTEOPOROSIS T score below –2.5 Reassure Lifestyle advice Treat if previous fracture Lifestyle advice Offer treatment* Calcium + Vitamin D Falls risk: Assessment/advice and Consider hip protectors RCP, 1999
Limitations Bone Mineral Density Focus on T Score Out of Date
Risk Assessment Age Gender Prior Fracture (after age 50 years) Parental history of fracture Current Smoking Alcohol intake > 2 units / day Ever Corticosteroid use Secondary causes (e.g. RA)
NICE 161– Secondary Prevention Alendronate (ALN) treatment of choice in post-menopausal women if T-score < – 2.5 Unable to take ALN – Risedronate (RIS) or etidronate (ETD) Unable to take RIS /ETD – Strontium / Raloxifene
* Age 75 +yrs + 2 or more risk factors – no need for BMD NICE 160– Primary Prevention * Age 70+ yrs + independent clinical risk factor for fracture OR clinical risk of low BMD + T- score of < – 2.5
NICE 160/161 Difficult to use – copy of guidance to hand Restrictive : only few risk factors Unfair ALN first line therapy – Using NOGG many patients will be NICE compliant
Summary Osteoporosis is major health problem Effective therapies are available Challenge is targeting treatment – at risk NOGG / FRAX new approach to assessment of risk Use of NOGG should help target treatment to individuals at risk
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