Osteoporosis, osteopenia and minimal trauma fractures are becoming increasingly common in the ageing population. Fractures cause increases in morbidity and mortality and have a significant financial impact on the healthcare system and society.Addressing risk factors for osteoporosis early may prevent or delay the onset of fractures and use of drugs. Calcium and vitamin D supplementation may benefit people with a high risk of deficiency (e.g. institutionalised older people) but may not be required in people without risk factors. Impact and resistance exercises and physical activity can increase bone density and prevent falls.Antiresorptive drugs such as bisphosphonates and denosumab remain first-line treatment options for osteoporosis. The ongoing need for bisphosphonates should be assessed after five years and treatment may then be interrupted in some patients. Progressive bone loss will recur slowly. Denosumab therapy should not be interrupted without switching to another therapy, as posttreatment bone loss can progress rapidly. All patients will need ongoing monitoring and most will require some long-term therapy once started.Raloxifene may be considered in women who do not tolerate first-line antiresorptive drugs. Romosozumab is a new anabolic treatment for osteoporosis and, together with teriparatide, is subsidised as second-line therapy for individuals with severe disease and multiple fractures. Specialist referral should be considered for patients who sustain fractures while undergoing osteoporosis therapy.predicted using the Garvan Fracture Risk or FRAX calculators. 6,7 Age, a family history of hip fractures and previous fractures are key risk factors. All men and women over the age of 50 years who have sustained a fracture have a higher risk of subsequent fractures and should be assessed and considered for treatment. Bone mineral density testing is also recommended and subsidised for all men and women over 70 years of age. Along with falls-risk screening, it is recommended as part of general health checks for all individuals, yet medical record audits indicate that this prevention strategy is currently underused. 8 Osteoporosis can be defined using bone mineral density testing, which generates a T-score and Z-score. The T-score reflects the number of deviations from the peak bone mass of age-, sex-and ethnicity-matched norms. A T-score less than -2.5 indicates a significant reduction in bone mass. The Z-score reflects the number of standard deviations from the average bone mass of age-, sex-and ethnicity-matched norms. A Z-score less than -2.0 should prompt a more complete search for secondary causes of osteoporosis.
Management strategiesAddressing lifestyle risk factors, appropriately treating predisposing conditions and minimising the unnecessary prescription of drugs associated with osteoporosis may slow the decline in bone