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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

Vikki Odell GP ST3

October 2010


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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


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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


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Osteoporosis

  • NICE Guidance refers to Primary Prevention as: osteoporosis confirmed with no # yet

  • NICE Guidance refers to Secondary Prevention as: osteoporosis confirmed & previous #


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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


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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)


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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


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Primary Prevention2- Risedronate & Etidronate

  • Intolerant of Alendronate

  • EXCEPT - If 65-69 with no independent # risk factor or indicators of low BMD


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Primary Prevention3 - Strontium

  • Intolerant of Alendronate, Risedronate & Etidronate

  • EXCEPT - If 65-69 with no independent # risk factor or indicator of low BMD


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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


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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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