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Osteoporosis

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

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  1. Osteoporosis Vikki Odell GP ST3 October 2010

  2. 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

  3. 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

  4. Osteoporosis • NICE Guidance refers to Primary Prevention as: osteoporosis confirmed with no # yet • NICE Guidance refers to Secondary Prevention as: osteoporosis confirmed & previous #

  5. 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

  6. 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)

  7. 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

  8. Primary Prevention2- Risedronate & Etidronate • Intolerant of Alendronate • EXCEPT - If 65-69 with no independent # risk factor or indicators of low BMD

  9. Primary Prevention3 - Strontium • Intolerant of Alendronate, Risedronate & Etidronate • EXCEPT - If 65-69 with no independent # risk factor or indicator of low BMD

  10. 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

  11. 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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