Osteoporosis

M80.00-59/M80.80-99/M81.00-69/M81.80-99/M82.00-19/M82.80-89

DESCRIPTION

A disease characterised by low bone mass and micro-architectural bone deterioration leading to bone fragility and increase in fracture risk.

GENERAL MEASURES

Prevention

Adequate energy and protein intake.

Adequate dietary calcium intake (>1 g/day) particularly in the young, in breastfeeding mothers and in the elderly. This is preferably obtained from a dietary source.

Weight bearing exercises, e.g. brisk 30-minute walk 3 times a week.

Smoking cessation.

Avoid excessive alcohol intake - >2 units daily has a 40% increased risk of sustaining any osteoporotic fracture, compared to people with moderate or no alcohol intake. Avoid falls.

LoEIII [34]

MEDICINE TREATMENT

Primary prevention

In institutionalised frail elderly patients, supplementation with calcium and vitamin D may reduce the incidence of hip fractures:

  • Calcium, elemental, oral, 1 000 mg daily.

LoEIII [35]

AND

  • Vitamin D (Calciferol), oral, 800 units daily or 50 000 units weekly.

Note: Routine supplementation with calcium and vitamin D marginally increases the risk of myocardial infarction and stroke and is of unclear benefit in other populations.

LoEIII [36]

For glucocorticoid-induced osteoporosis, i.e. patient on long-term (>3 months) corticosteroids at doses ≥5 mg/day: M81.80-M81.89

LoEIII [37]

  • Bisphosphonates, e.g.:
  • Alendronic acid, oral, 70 mg weekly, for a maximum duration of 5 years.
    • Taken with a full glass of water, 30 minutes before breakfast – do not lie down.

Secondary prevention

Secondary prevention of osteoporotic fracture:

In severe osteoporosis, i.e. patients who have a T-score of –2.5 (severe osteoporosis) plus an osteoporotic fracture:

LoEI [38]

  • Bisphosphonates, e.g.:
  • Alendronic acid, oral, 70 mg weekly, for a maximum duration of 5 years.
    • Taken with a full glass of water, 30 minutes before breakfast – do not lie down.

Supplement bisphosphonate therapy with:

  • Calcium, elemental, oral, 1 000mg daily.

AND

  • Vitamin D (Calciferol), oral, 800 units daily.

Hormone replacement therapy

See Menopause and perimenopausal .

Only indicated early in menopause, if vasomotor symptoms are significant.

Review contra-indications before initiating therapy.

REFERRAL

  • Initial assessment.Initiation of, and monitoring response to, therapy, and 18–24 monthly bone mineral density (BMD), where required.
  • Fractures suspected to be due to osteoporosis for consideration for bisphosphonates.
  • Patients not tolerating oral bisphosphonate.
  • Patients with e-GFR < 30 mL/minute.