This episode focuses on osteoporosis with guest speaker Dr Saadat Ahmed, specialist in geriatrics. Drs Lisa and Sarah talk to Dr Saadat about what osteoporosis is, what the risks factors are, who and how to assess for it, and what to do with the results from Fracture Risk Assessment Tool (FRAX) and bone density (DEXA) scans.
After a discussion on lifestyle options to help improve bone health, they also cover information on counselling patients around the pros and cons of taking Bisphosphonates, including Dr Saadat’s advice on the rarer side effects.
They go on to discuss a case and provide advice on how to reassess bone health after initial conversations and medications may have already started, including when to consider drug holidays.
Listen to the podcast episode at https://pckb.org/e/osteoporosis/
Useful resources:
- Osteoporosis – Prevention of Fragility Fractures NICE CKS Guidelines (updated Apr 2023): https://cks.nice.org.uk/topics/osteoporosis-prevention-of-fragility-fractures/
- FRAX Calculator UK (Link from National Osteoporosis Guideline Group UK: https://frax.shef.ac.uk/FRAX/tool.aspx?country=1
- WHO Falls Management: https://www.who.int/news-room/fact-sheets/detail/falls
- National Osteoporosis Guideline Group UK: https://www.nogg.org.uk/full-guideline/section-4-intervention-thresholds-and-strategyhttps://www.nogg.org.uk/full-guideline/section-7-strategies-management-osteoporosis-and-fracture-risk
- SIGN Scottish Osteoporosis Guidelines (discussion of evidence for links between PPIs and Osteoporosis on page 27): https://www.sign.ac.uk/media/1812/sign-142-osteoporosis-v3.pdf
- Osteonecrosis of the Jaw relative risk discussed on page 37 of National Osteoporosis Guideline Group UK: https://www.nogg.org.uk/sites/nogg/download/NOGG-Guideline-2021-g.pdf
- Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus, Journal of Bone and Mineral Research. Khan A et al 2015: https://pubmed.ncbi.nlm.nih.gov/25414052/
- Flow Chart for Oral Bisphosphonates long term treatment and monitoring NOGG Guidelines: Page 35: https://www.nogg.org.uk/sites/nogg/download/NOGG-Guideline-2021-g.pdf
- Rubin KH, Rothmann MJ, Holmberg T, et al. Effectiveness of a two-step population-based osteoporosis screening program using FRAX: the randomized Risk-stratified Osteoporosis Strategy Evaluation (ROSE) study. Osteoporosis Int 2018; 29(3): 567-78. https://pubmed.ncbi.nlm.nih.gov/29218381/
- Merlijn T, Swart KM, van Schoor NM, et al. The Effect of a Screening and Treatment Program for the Prevention of Fractures in Older Women: A Randomized Pragmatic Trial. J Bone Miner Res 2019; 34(11): 1993-2000. https://pubmed.ncbi.nlm.nih.gov/31220365/
- Merlijn T, Swart KMA, van der Horst HE, Netelenbos JC, Elders PJM. Fracture prevention by screening for high fracture risk: a systematic review and meta-analysis. Osteoporosis Int 2020; 31(2): 251-7. https://pubmed.ncbi.nlm.nih.gov/31838551/
