Clinical Opal #19 - ‘The thigh bone's connected to the hip bone’

Yes, Mary has osteoporosis.

Her diagnosis is confirmed by the fact that she has suffered a fracture after minimal trauma. A minimal trauma fracture is defined as ‘one that occurs after a fall from standing height or less, or from a minor force that would not normally cause a fracture in a healthy younger person’.¹

While a DEXA scan may be useful to establish a baseline to assess future response to treatment, it is not required to confirm the diagnosis of osteoporosis and commence anti-resorptive treatment. It is important to note that BMD is only one of several factors that contribute to an person’s risk of fracture. Indeed, approximately 50% of minimal trauma fractures occur in people who have T-scores in the normal or osteopenic range.²

PBS subsidies for pharmacotherapy apply to people who:

• Have had a minimal trauma fracture
• Are aged over 70 years with low bone density
• Have low bone density and taking corticosteroids^3,4

A previous minimal trauma fracture doubles a person’s risk of subsequent fracture. This makes it essential to manage patients who have suffered a minimal trauma fracture to prevent subsequent fractures.

References:

1. RACGP Red Book. Guidelines for preventive activities in general practice: Osteoporosis. 2021
2. RACGP and Osteoporosis Australia. Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age. 2nd edn. 2017.
3. Australian Prescriber 2022. Treating osteoporosis: risks and management
4. NPS Medicinewise. Preventing fractures in osteoporosis.