Guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK☆,☆☆
Section snippets
Diagnosis of osteoporosis
The diagnosis of osteoporosis relies on the quantitative assessment of bone mineral density (BMD), usually by central dual energy X-ray absorptiometry (DXA). BMD at the femoral neck provides the reference site. It is defined as a value for BMD 2.5 SD or more below the young female adult mean (T-score less than or equal to −2.5 SD). Severe osteoporosis (established osteoporosis) describes osteoporosis in the presence of one or more fragility fractures [5].
Diagnostic thresholds differ from
Investigation of osteoporosis
The range of tests will depend on the severity of the disease, age at presentation and the presence or absence of fractures. The aims of the clinical history, physical examination and clinical tests are to:
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exclude diseases that mimic osteoporosis (e.g. osteomalacia, myeloma);
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identify the cause of osteoporosis and contributory factors;
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assess the risk of subsequent fractures;
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select the most appropriate form of treatment;
The procedures that may be relevant to the investigation of osteoporosis are
Clinical risk factors
At present there is no universally accepted policy for population screening in the UK to identify individuals with osteoporosis or those at high risk of fracture. Patients are identified opportunistically using a case finding strategy on the finding of a previous fragility fracture or the presence of significant clinical risk factors (CRFs). Some of these risk factors act independently of BMD to increase fracture risk (Table 2) whereas others increase fracture risk through their association
Case finding
Fracture risk should be assessed in postmenopausal women and in men aged 50 years or more with the risk factors outlined where assessment would influence management.
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Women with a prior fragility fracture should be considered for treatment without the need for further risk assessment although BMD measurement may sometimes be appropriate, particularly in younger postmenopausal women.
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In the presence of other CRFs, the 10 year probability of a major osteoporotic fracture (clinical spine, hip,
Treatment of osteoporosis
General management includes assessment of the risk of falls and their prevention. Maintenance of mobility and correction of nutritional deficiencies, particularly of calcium, vitamin D and protein, should be advised. Intakes of at least 1000 mg/day of calcium, 800 IU of vitamin D and of 1 g/kg body weight of protein can be recommended.
Major pharmacological interventions are the bisphosphonates, strontium ranelate, raloxifene and parathyroid hormone peptides. All these interventions have been shown
Glossary
- BMD
- bone mineral density
- BMI
- body mass index; weight (kg)/height (m2)
- CRF
- clinical risk factor for fractures due to osteoporosis
- DXA
- dual energy X-ray absorptiometry
- FRAX®
- the WHO fracture risk assessment tool
- SD
- standard deviation (of BMD measurements)
- T-score
- the number of standard deviations that a BMD measurement lies above or below the average value for young healthy women
References (7)
- Royal College of Physicians. Osteoporosis: clinical guidelines for the prevention and treatment. London: Royal College...
- Royal College of Physicians and Bone and Tooth Society of Great Britain. Update on pharmacological interventions and an...
- Royal College of Physicians. Glucocorticoid-induced osteoporosis. Guidelines on prevention and treatment. Bone and...
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Supported by the ‘Invest in your Bones Campaign’ of the International Osteoporosis Foundation.
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The recommendations in the guideline should be used to aid management decisions but do not replace the need for clinical judgement in the care of individual patients in clinical practice.