lcp
We have detected you are using Internet Explorer. To provide the best and most secure experience, please use a modern browser as we do not support Internet Explorer.

A quick look at the Australian osteoporosis guidelines

29 September 2017 - Dr Cathy Regan

Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age 2nd Edition

I was about to check out the new Australian osteoporosis guidelines when the new UK guidelines were announced in ANZAC week, so I decided to look at these as well.  Reassuringly, most recommendations are fairly similar. The Australian document is contributed to by Osteoporosis Australia and the RACGP and the UK one by about a dozen groups.  

At 98 pages, the new Australian 2nd edition guidelines are a bit longer than the previous 2010 version (and three times larger than the UK document).  Getting the balance right between usability and comprehensiveness is tricky. The more I read this document, the more I liked it although I did think that it was not entirely clear at times whether the outcome focus was osteoporosis or fractures/ falls.

What has changed

  • The status of evidence regarding the role of exercise (more encouraging but also more specific);
  • One new useful medication -  denosumab (prolia).  Unfortunately, like the bisphosphonates, it also has reports of osteonecrosis of the jaw and atypical femur fracture;
  • Some discussion re online tools for absolute fracture risk – giving options of FRAX and the GARVAN tool.  I tried both on myself and got slightly different results. The UK recommend FRAX specifically in their algorithm and have some interesting background discussion;
  • Some refining, based on ongoing evidence, of recommendations regarding calcium and vitamin D (see Recommendations 14, 27, 32). This includes delineating those who should be advised to take supplements if appropriate (frail and institutionalized elderly plus those on osteoporosis treatment with inadequate dietary calcium) and those who shouldn’t routinely be so advised (non-institutionalised). The guidelines note that not all studies support the recently reported association between supplemental calcium and increased myocardial infarction risk. They also note the report of an association between higher dose vitamin D and increased falls.

What I liked in the Australian guidelines

  • Four page summary of 42 recommendations graded A-D;
  • The chapters on special groups (elderly and those treated for cancer of breast and prostate);
  • Advice on how long to treat and when to reassess;
  • Background detail and evidence when you want it;
  • The algorithm is OK.

In summary

The algorithm distinguishes between patients with hip/vertebral fractures, other fragility fractures and no fractures. It then differentiates on age and BMD.  It includes use of clinical risk factors and a Risk Calculator – but further down the algorithm than in the UK document.

The introduction stated that only 20% of patients with minimal trauma fractures are adequately managed in general practice but the reference was from 2004.  Both new guidelines noted that the most effective system is to have Secondary Fracture Prevention programs with a coordinator after hospital admission.  I don’t think this happens universally in Australia.

Links

New Osteoporosis guidelines (Australia)

National Osteoporosis Guidelines Group (UK) 

Online tools: FRAX     

Garvan risk calculator 

Dr Cathy Regan
Dr Cathy Regan

Cathy (AM, BSocStud(hons), LittB, BMed, FRACGP, PhD) is a GP in Newcastle, NSW, who has been involved in medical education (at undergraduate, vocational and postgraduate level) for many years. Her PhD was in the area of frailty.

Get Medcast Plus

Become a member and get unlimited access to 100s of hours of premium education.

Learn more
Related News
James presents with acute shortness of breath and a wheeze during a summer soccer match - clinical opal

Susan Helmrich

James, a university student with a history of seasonal allergic rhinitis, presents with sudden respiratory distress following exposure to grass pollen during a soccer game shortly before a summer thunderstorm. Could this be thunderstorm asthma?

5 mins READ
Antidepressants in older adults: handle with CARE

Quality Use of Medicines Alliance

Brand icon

Explore patient-centred strategies for managing antidepressant use in older adults using the mnemonic CARE as a framework for effective decision-making, monitoring, and deprescribing. Learn how the Quality Use of Medicines Alliance promotes safer, tailored approaches to mental health management in older populations.

5 mins READ
Essential guide to DVA billing

Dr Catherine Eltringham

Brand icon

Navigating the world of Department of Veterans' Affairs (DVA) billing can seem daunting. This concise guide provides general practitioners (GPs) with essential information on claiming for key DVA services, incentive payments, and compensation claim paperwork, ensuring accurate and efficient processing of your claims.

10 mins READ