The Management of Osteoporosis

Abstract

Osteoporosis poses a significant orthopaedic problem of epidemic proportions. Clear guidelines for the management of osteoporosis presenting early or late are still being debated. Several recommendations, however, are now generally accepted. Measurements of BMD should be taken if the diagnosis is in doubt or as an adjunct to encourage patient compliance with treatment. Those with multiple risk factors and who are under the age of 65 years would benefit from a scan. Those with previous fractures and no obvious risk factors should also be sent for DXA assessment. The elderly with fractures and multiple risk factors do not need scanning and can normally be started on treatment. Mass population screening is not cost-effective. Prevention strategies should be targeted at high-risk patients and not offered to everyone. In the perimenopausal woman HRT is the first line of treatment and prevention, along with changes in lifestyle. Tibolone may be an option for those who find cyclical bleeding unacceptable. In the elderly, institutionalised patient, calcium and vitamin-D supplements should be considered to replace depleted levels, particularly for secondary prevention. Postmenopausal women with multiple risk factors and at least one insufficiency fracture should be treated. The most likely pharmacological agent will be a bisphosphonate with supplemental calcium if indicated. Each hospital should have a recognised link person through whom referrals can be channelled, either a clinical nurse specialist or physician. A protocol for treatment should be agreed locally and publicised among the primary health-care groups. The first step of identification of high-risk patients is most often in fracture clinics. Standardised letters attached to the clinic note to general practitioners are an easy way of 'getting these patients into the system'.

One fracture is enough!: Experience with a prospective and consecutive osteoporosis screening program with 239 fracture patients

“…Osteoporosis screening for fracture patients has been suggested by several authors (Tosi andLane 1998, Stephen andWallace 2001). However, screening routines must be organized in orthopedic departments where the patients are seen.…”

Cost-Effectiveness Analysis of Various Screening Methods for Osteoporosis in Perimenopausal Thai Women

“…As the cost increased to 250,000 USD (100 times the current estimate), the most cost effective strategy shifted from no intervention to screening with risk index alone [21] . As the cost increased to 500,000 USD (200 times the current estimate), universal treatment became the most cost effective strategy.…”

Bilateral atypical insufficiency fractures of the proximal tibia and a unilateral distal femoral fracture associated with long-term intravenous bisphosphonate therapy: a case report

“…Insufficiency fractures differ from stress fractures, in that the bone is abnormal in terms of mineralization, elasticity and ability to repair from injury, and so normal physiological activity can result in fracture [22]. The majority of documented cases have occurred in patients using alendronate, which is the most commonly used bisphosphonate.…”