Guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK

doi:10.1016/j.maturitas.2008.11.022

Maturitas

Volume 62, Issue 2, 20 February 2009, Pages 105-108

https://doi.org/10.1016/j.maturitas.2008.11.022 Get rights and content

Abstract

In 1999 and 2000 the Royal College of Physicians published guidelines for the prevention and treatment of osteoporosis [Royal College of Physicians. Osteoporosis: clinical guidelines for the prevention and treatment. London: Royal College of Physicians; 1999; Royal College of Physicians and Bone and Tooth Society of Great Britain. Update on pharmacological interventions and an algorithm for management. London, UK: Royal College of Physicians; 2000.; Royal College of Physicians. Glucocorticoid-induced osteoporosis. Guidelines on prevention and treatment; Bone and Tooth Society of Great Britain, National Osteoporosis Society and Royal College of Physicians. London, UK: Royal College of Physicians; 2002]. Since then, there have been significant advances in the field of osteoporosis including the development of new techniques for measuring bone mineral density, improved methods of assessing fracture risk and new treatments that have been shown to significantly reduce the risk of fractures. Against this background, the National Osteoporosis Guideline Group (NOGG), in collaboration with many Societies in the UK, have updated the original guidelines [Royal College of Physicians, National Osteoporosis Guideline Group on behalf of the Bone Research Society, British Geriatrics Society, British Orthopaedic Association, British Society of Rheumatology, National Osteoporosis Society, Osteoporosis 2000, Osteoporosis Dorset, Primary Care Rheumatology Society, Society for Endocrinology. Osteoporosis. Clinical guideline for prevention and treatment, Executive Summary. University of Sheffield Press; 2008], a practical summary of which is detailed below. The management algorithms are underpinned by a health economic analysis applied to the epidemiology of fracture 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:

•
exclude diseases that mimic osteoporosis (e.g. osteomalacia, myeloma);
•
identify the cause of osteoporosis and contributory factors;
•
assess the risk of subsequent fractures;
•
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.
•
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...

There are more references available in the full text version of this article.

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^☆: Supported by the ‘Invest in your Bones Campaign’ of the International Osteoporosis Foundation.

^☆☆: 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.

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Guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK☆,☆☆