Love your bones, protect your future: it’s time to make osteoporosis my squeaky wheel

As World Osteoporosis Day approaches this October 20th, join me in making this clinical issue our squeaky wheel and pay some extra attention to it.

The breadth of what I see and manage in general practice is both what excites me and challenges me every day. I seem to be constantly familiarising myself with the new and the updated; just in the past 1-2 years:

  • RACGP and RACS find some common ground on prostate cancer screening;
  • The renewed national cervical cancer screening program;
  • Meningococcal immunisation beyond men C: men B and now men ACYW;
  • New hepatitis C treatment regimens; and the list goes on…

Each update or breakthrough is accompanied by its marketing material, its own campaign to get my attention, its own “squeaky wheel” strategy.

But what about the silent killers?

World Osteoporosis Day is October 20th, reminding me that osteoporosis is a silent killer in my practice; by the time it makes a noise, I am too late. Osteoporosis is under recognised and undertreated. So it’s up to me, and you, to actively screen for it, diagnose it and manage it.

Why?

  • Morbidity related to fractures includes pain, reduced mobility, loss of function and an associated loss of quality of life, including the ability to live independently
  • Mortality in the first year after a major minimal trauma fracture in people older than 60 years of age is up to three times higher than in age-matched non-fracture populations for people with hip fracture and up to two times higher for other major fracture types.
  • Excess mortality occurs mainly in the first five years after a minimal trauma fracture but may continue up to 10 years following the fracture.
  • Fewer than 20% of patients presenting with minimal trauma fractures to hospitals or general practice are investigated or treated for osteoporosis.
  • Failure to prevent secondary fracture is one of the largest gaps in the practice of evidence-based medicine in Australia.

In March 2017, Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age, 2nd edition was developed by Osteoporosis Australia and published by RACGP.

It is a useful and useable guideline addressing current updated recommendations on:

    • Risk factor assessment, diagnosis and referral, including:
      • Identifying patients to investigate for osteoporosis
      • Diagnostic investigations
      • Assessing which of our patients may be assisted by management shared with a specialist
    • General bone health maintenance and fracture prevention
    • Pharmacologic approaches to prevention and treatment
    • Ongoing monitoring
    • Other special issues, including:
      • Application to over 75 year olds and residential patients
      • Falls prevention considerations
      • Fracture prevention considerations

In addition to the full guideline, a two page summary and flowchart, Osteoporosis flowchart and summary of key practice recommendations, has been developed and is accessible online.

In addition to these useful guidelines, I find the following sites useful for my own information: NPS MedicineWise, Therapeutic Guidelines and Osteoporosis Australia. For patient information, visit Osteoporosis AustraliaKnow your Bones and Healthy Bones Australia.

In conclusion, as World Osteoporosis Day approaches, join me in making this clinical issue our squeaky wheel and pay some extra attention to it.

 

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