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Osteoporosis. Vikki Odell GP ST3 October 2010. Osteoporosis. Osteoporosis is a loss of bone density sufficient to cause an increased risk of fracture. The WHO Working Group defines Osteoporosis according to measurements of bone mineral density (BMD)

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osteoporosis

Osteoporosis

Vikki Odell GP ST3

October 2010

osteoporosis2
Osteoporosis
  • Osteoporosis is a loss of bone density sufficient to cause an increased risk of fracture.
  • The WHO Working Group defines Osteoporosis according to measurements of bone mineral density (BMD)
  • Osteoporosis is defined as a bone density T score at or below 2.5 SDs below normal peak values for young adults
osteoporosis3
Osteoporosis
  • normal BMD: T-score of -1 SD or above
  • osteopenia: T-score of between -1 and -2.5 SD
  • osteoporosis: T-score of -2.5 SD or below
  • established (severe) osteoporosis: T-score of -2.5 SD or below with one or more associated fractures
osteoporosis4
Osteoporosis
  • NICE Guidance refers to Primary Prevention as: osteoporosis confirmed with no # yet
  • NICE Guidance refers to Secondary Prevention as: osteoporosis confirmed & previous #
risk factors for osteoporosis
Risk Factors for Osteoporosis
  • Independent clinical risk factors for fracture:
  • Parental history of hip fracture
  • Alcohol intake of 4 or more units a day
  • Prior fracture
  • Rheumatoid arthritis (RA)
  • Indicators of low BMD:
  • Low body mass index (BMI) (<22kg/m2)
  • Medical conditions e.g. ankylosing spondylitis, Crohn\'s disease, RA
  • Conditions that result in prolonged immobility
  • Untreated premature menopause
primary prevention nice guidance 2008
Primary Prevention NICE Guidance (2008)
  • Post-menopausal women who have osteoporosis confirmed (T-Score >-2.5)
  • Diagnosis may be assumed without DEXA if > 75 years
  • Assumes Vit D & Calcium levels normal (if not supplement)
primary prevention 1 alendronate
Primary Prevention1- Alendronate
  • Over 70 years who have an independent # risk factor (parental hip #, RA, >4 units alcohol/day) OR an indicator of low BMD (low BMI, Ank Spond, Crohns, prolonged immobility, untreated menopause)
  • Over 75 and have 2 independent # risk factors OR indicators of low BMI
  • 65-69 AND independent # risk factor
  • Postmenopausal under 65 AND independent # risk factor AND indicator of low BMD
primary prevention 2 risedronate etidronate
Primary Prevention2- Risedronate & Etidronate
  • Intolerant of Alendronate
  • EXCEPT - If 65-69 with no independent # risk factor or indicators of low BMD
primary prevention 3 strontium
Primary Prevention3 - Strontium
  • Intolerant of Alendronate, Risedronate & Etidronate
  • EXCEPT - If 65-69 with no independent # risk factor or indicator of low BMD
secondary prevention nice guidance 2008
Secondary Prevention NICE Guidance (2008)
  • Alendronate
  • Risedronate & Etidronate – EXCEPT 50-54 with no independent # risk factors or indicator for low BMD
  • Strontium – EXCEPT 50-54 with no independent # risk factors or indicator for low BMD
references
References
  • http://www.gpnotebook.co.uk/simplepage.cfm?ID=x20100127104213017540&linkID=72984&cook=yes
  • Scondary Precention: http://www.nice.org.uk/nicemedia/live/11748/42508/42508.pdf
  • Primary Prevention: http://www.nice.org.uk/nicemedia/live/11746/42486/42486.pdf
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