Lecture Notes
Osteoporosis – capture the fracture, by Dr Adrian Taylor

Did you know that most osteoporotic fractures are being missed? In this talk at the SMA March Medical Update, Dr Adrian Taylor (Endocrinologist) reminded us that currently only about 1 in 5 osteoporotic fractures get treatment. Having a minimal-trauma fracture is a massive risk for having another fracture (1 in 5 refracturing within a year), and 20-25% of women die within a year of a hip fracture, so we need to do better at diagnosis and treatment.

The great news is that treatment helps: nearly all patients on anti-resorptive treatment get an increase in bone density. The bad news is that it doesn’t help everyone: the reduction in fracture risk is about 50% with any of the available drugs.

So how do we stop missing so many of these fractures? The RACGP guidelines for osteoporosis are useful, especially the 1-page flowchart.

If you’re a GP, you’ve probably seen plenty of Bone Mineral Density results before. Generally, Dr Taylor encouraged us to move away from relying on Bone Mineral Density alone to diagnose osteoporosis and decide on treatment, towards better estimating the patient’s individual risk of fracture. There are 2 alternative calculation tools available, but Dr Taylor likes FRAX better:

Unfortunately there are quite limited criteria for who we can treat with anti-resorptive drugs according to the current PBS criteria.  Key points to note are that if they already have a minimal-trauma fracture (i.e. from standing height), they already have established osteoporosis and will qualify for anti-resorptive treatment even without a Bone Mineral Density test. Also, if they’ve had long term corticosteroids, they qualify for treatment at a BMD of only -1.5 or lower.

 

Last but certainly not least, here is the video that wouldn’t quite play on the day for those who attended:

Osteoporosis

Here are some quick review questions based on the talk by Dr Adrian Taylor. Have a go – it’s anonymous, no strings attached!

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