Osteoporosis detection and treatment

Posted by e-Medical PPT Tuesday, September 18, 2012
Osteoporosis : Definition (NIH, 2001)
A skeletal disorder characterised by compromised bone strength predisposing a person to an increased risk of fracture.  Bone strength primarily reflects integration of bone density and bone quality.
1 in 2 women and 1 in 5 men aged 50 will suffer a fragility fracture in their remaining lifetime
There are 20 million people aged 50 years and over in the UK.  By 2020 this will have increased to 25 million.
The lifetime risk of fracture in women at age 50 is greater than the risk of breast cancer or cardiovascular disease

Annual Incidence of Osteoporotic fractures in England and Wales
180,000    Symptomatic osteoporotic fractures
    70,000    Hip fractures
    25,000    Vertebral fractures
    41,000    Wrist fractures

Management of Osteoporosis
Identifying Risk Factors for Osteoporosis
Previous fragility fracture
Corticosteroid use > 3 months
Family history, especially maternal hip fracture
Medical conditions associated with osteoporosis e.g. RA, coeliac disease, hyperparathyroidism
Premature menopause < 45 years old
Excess alcohol consumption
Low BMI (<19)
Smoking

REASON FOR REFERRAL:
Corticosteroid therapy – any dose for more than three months.  However, patients of any age who have had a minimal trauma fracture or patients >65 treat without a scan.
Minimal trauma fracture – eg wrist, vertebra, hip, pelvis.  If known vertebral fracture, please state which vertebra.
Early menopause – before 45 years, or prolonged amenorrhoea > 1 year – scan when patient reaches 50 years of age.
Other diseases or treatments associated with osteoporosis
Family History of osteoporosis in first degree relative, particularly maternal hip fracture.
Significant radiological osteopenia
Patients with proven osteoporosis who discontinue HRT and who are not on other OP treatment.  Scan 12 months after stopping
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