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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’

NICE guidelines for osteoporosis

Health care professionals:

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