Australian Institute of Health and Welfare (2020) Osteoporosis, AIHW, Australian Government, accessed 02 December 2022.
Australian Institute of Health and Welfare. (2020). Osteoporosis. Retrieved from https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoporosis
Osteoporosis. Australian Institute of Health and Welfare, 25 August 2020, https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoporosis
Australian Institute of Health and Welfare. Osteoporosis [Internet]. Canberra: Australian Institute of Health and Welfare, 2020 [cited 2022 Dec. 2]. Available from: https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoporosis
Australian Institute of Health and Welfare (AIHW) 2020, Osteoporosis, viewed 2 December 2022, https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoporosis
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Diagnosis of osteoporosis requires an assessment of bone mineral density (BMD). The most commonly used technique is a specialised X-ray known as a 'Dual energy X-ray Absorptiometry (DXA) scan' to determine bone mineral density (BMD) in the hips and spine (IOF 2017). Scan results are expressed as T-scores which compare a person's BMD with the average of young healthy adults (Table 1).
1 to –1
–1 to –2.5
–2.5 or lower
Source: WHO Study Group 1994.
Osteoporosis is largely a preventable disease. The goal of the prevention and treatment of osteoporosis is to maintain bone density and reduce a person’s overall fracture risk (RACGP 2018).
Quality of life can be severely compromised for people with osteoporosis, particularly if they fall and sustain a fracture. Wrist and forearm fractures may affect the ability to write, type, prepare meals, perform personal care tasks and manage household chores. Fractures of the spine and hip can affect mobility, making activities such as walking, bending, lifting, pulling or pushing difficult. Hip fractures, in particular, often lead to a marked loss of independence and reduced wellbeing.
Primary prevention of osteoporosis involves supplementing diet to get sufficient calcium and vitamin D, and behaviour modification such as regular weight-bearing and resistance exercise, keeping alcohol intake low and not smoking, and fall reduction strategies (RACGP 2018).
There is a diverse range of medicines available for osteoporosis management, so treatment selection is guided by a number of factors including sex, “menopausal status, medical history, whether it is for primary or secondary fracture prevention, patient preference and eligibility for government subsidy” (Bell et al. 2012).
Oral and intravenous bisphosphonates, and subcutaneous denosumab injections are among the recommended first-line pharmacological therapy for both males and females with osteoporosis (RACGP 2018). These medicines “slow bone loss, improve bone mineral density and reduce fracture rates” (RACGP 2018). Bone building drugs, such as daily teriparatide (RACGP 2018) and monthly romosozumab injections, are reserved as second-line treatments when first-line treatments fail.
People with osteoporosis can be hospitalised for a range of reasons, including minimal trauma fractures. These fractures can occur from a minor bump, fall from a standing height or an event that would not normally result in a fracture if the bone was healthy.
Minimal trauma fractures generate substantial costs to the community, including with direct costs in terms of hospital treatment. Data from the National Hospital Morbidity Database (NHMD) show that in 2017–18 there were 6,838 hospitalisations with a principal diagnosis of osteoporosis for people aged 50 and over. The hospitalisation rate for people with osteoporosis was greatest for people aged 85 and over (Figure 1). Among individuals 50 years and above, the hospitalisation rate was higher in females than in males (122 compared with 41 per 100,000 persons in 2017-18).
Source: AIHW National Hospital Morbidity Database (Data table).
Minimal trauma fractures may be the result of osteoporosis, which is commonly undiagnosed prior to a fracture. A range of other factors, such as high bone turnover, low body weight and a tendency to fall, also increase minimal trauma fracture risk. As osteoporosis is not common before the age of 50, minimal trauma fractures occurring in people age 50 or over are more likely to be a result of osteoporosis.
Minimal trauma hip fracture is one of the most serious and debilitating outcomes of osteoporosis (Ip et al. 2010). In 2015–16, there were an estimated 18,700 new hip fractures among Australians aged ≥45 years—a crude (age-specific) rate of 199 fractures per 100,000 population (AIHW). Treatment of this type of fracture invariably requires hospitalisation, may require surgery, and may be a source of ongoing pain and disability. These fractures are a considerable burden to individuals, the community and the Australian health system due to their high cost (Watts et al. 2013).
AIHW (Australian Institute of Health and Welfare) 2018. Hip fracture incidence and hospitalisations in Australia 2015–16. Cat. no. PHE 226. Canberra: AIHW.
Bell JS, Blacker N, Edwards S, Frank O, Alderman CP, Karan L et al. 2012. Osteoporosis: Pharmacological prevention and management in older people. Australian Family Physician 41(3) 110-118.
Ip TP, Leung J & Kung AWC 2010. Management of osteoporosis in patients hospitalized for hip fractures. Osteoporosis International 21 (Suppl 4):S605–S614.
IOF (International Osteoporosis Foundation) 2017. Diagnosing Osteoporosis. Viewed 23 January 2020.
RACGP (The Royal Australian College of General Practitioners) and OA (Osteoporosis Australia) 2017. Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age. 2nd edn. East Melbourne, Vic: RACGP.
RACGP 2018. Guidelines for preventive activities in general practice. 9th edn, updated. East Melbourne, Vic: RACGP.
Watts JJ, Abimanyi-Ochom J & Sanders KM 2013. Osteoporosis costing all Australians: A new burden of disease analysis–2012 to 2022. Sydney: Osteoporosis Australia.
WHO (World Health Organization) Study Group 1994. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO Technical Report Series 843:3–5.
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