Osteoporosis

Osteoporosis9th January 2013

Dr Julian TomkinsonRCGP Curriculum3.06 Womens HealthBe able to advise on prevention strategies relevant to women

3.20 Care of People with Musculoskeletal ProblemsAwareness treatment of fragility fracture in osteoporosisNICEDirect medical costs of fragility fractures to the UK healthcare economy estimated at 1.8 billion in 2000, with the potential to increase to 2.2 billion by 2025

Most of these costs relating to hip fracture careQOF 2012Producing a register of patients (a) aged 50-74 years with a record of a fragility fracture after 1 April 2012 and a diagnosis of osteoporosis confirmed on DXA scan; or (b) aged 75 years and over with a record of a fragility fracture after 1 April 2012

Ensuring that patients on the register who are aged between 50 and 74 years, with a fragility fracture, in whom osteoporosis is confirmed on DXA scan, are treated with an appropriate bone-sparing agent

Ensuring that patients aged 75 years and over with a fragility fracture are treated with an appropriate bone-sparing agent.

StatisticsApproximately 14,000 people die per year from osteoporosis (greater than carcinoma of ovary, uterus and cervix put together)Patients who sustain a vertebral fracture consult their GP, on average, 14 extra times in the year following it.The mortality of hip fracture in older patients is 20% at three months

Osteoporosis (porous bones)a progressive systemic skeletal disease characterised by reduced bone mass/density and micro-architectural deterioration of bone tissueOsteoporotic (Fragility) FractureFractures that result from mechanical forces that would not ordinarily result in fracture (fracture caused by a force equivalent to the force of a fall from a standing height or less)

Defined as fractures associated with low bone mineral density. Can affect spine, forearm, hip and shoulder fractures

Osteoporosis: hip BMD 2.5 SD or more below the young adult reference mean (T-score -2.5)

Severe osteoporosis:T-score -2.5 PLUS fracture

Low bone mass (osteopenia):T-score less than -1 but above -2.5

Normal:T-score -1

Bone Mineral Density (BMD)WHO / IOF standardsPrevalencePrevalence of osteoporosis increases markedly with age(2% at 50 years to more than 25% at 80 years in women)

NICE estimates there are 2 million women who have osteoporosis in England and WalesRisk Factors for fragility fractureAgeLow BMDParental history ofhip fracture.Alcohol intake of four or more units per day.Rheumatoid arthritis.

Risk factors for reduced BMDFemale genderCorticosteroid therapy orCushing's syndromeAnkylosing spondylitisCrohn's diseaseUntreatedpremature menopause(