Treatment and management of osteoporosis

Diagnosing osteoporosis

Diagnosis of osteoporosis requires a specialised X-ray known as a 'Dual energy X-ray Absorptiometry (DXA) scan' to determine the bone mineral density (BMD) in hips and spine. Scan results are expressed as T-scores which compare a person's BMD with the average of young healthy adults (Table 1).

Table 1: Diagnosing osteoporosis using bone density testing

 

Normal

Osteopenia

Osteoporosis

T-Score

1 to –1

–1 to –2.5

–2.5 or lower

Source: WHO Study Group 1994 [1].

Preventing and managing osteoporosis

Osteoporosis is largely a preventable disease. Primary prevention includes getting enough calcium and vitamin D, keeping physically active, maintaining a healthy weight, keeping alcohol intake low and not smoking [2].

Osteoporosis is managed using medicine, behaviour modification and medical care. Medicines for managing osteoporosis include drugs that reduce bone breakdown, which must be administered regularly. These include oral bisphosphonates, intravenously administered bisphosphonate (zoledronic acid), and an injection given under the skin (denosumab) [3]. People with osteoporosis are encouraged to prevent fractures by avoiding falls. When fractures do occur they should be managed promptly, in particular hip fractures [2].

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 or 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.

Hospitalisation for osteoporosis

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 2016–17 there were 7,382 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). After adjusting for age, the hospitalisation rate was higher in females than in males (135 compared with 43 per 100,000 population).

Figure 1: Rate of hospitalisation for osteoporosis, people aged 50 and over, by age and sex, 2016–17

The vertical bar chart shows that in 2016–17, the age-adjusted hospitalisation rate (per 100,000 population) for the principal diagnosis of osteoporosis was greater for females than males. The hospitalisation rate increased with age and was highest in people aged 85 and over for both males (193) and females (598). Hospitalisation rates were lowest in people aged 50-54 (11 for males, 20 for females).

Source: AIHW National Hospital Morbidity Database (Data table).

Minimal trauma fractures

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 contribute to 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.

In 2016–17:

  • there were 85,509 hospitalisations for minimal trauma fractures in people aged 50 and over
  • the hospitalisation rate for minimal trauma fractures in people aged 50 and over was higher in females (1,464 per 100,000 people) than in males (617 per 100,000).
  • of all hospitalisations for minimal trauma fractures for people aged 50 and over, 35% were for people aged 85 and over
  • the most common fracture sites were the hip (32%), the forearm (13%) and lumbar spine and pelvis (13%) (Figure 2).

Figure 2: Hospitalisations following minimal trauma by fracture site, people aged 50 and over, 2016–17

Figure 2 shows that hip fractures were the most common site for a minimal trauma fracture in hospitals (26,721 hospitalisations), followed by other sites (17,806 hospitalisations), forearm (11,238 hospitalisations), lumbar spine and pelvis (10,654 hospitalisations), lower leg including ankle (9,720 hospitalisations), and shoulder and upper arm (9,370 hospitalisations).

Source: AIHW National Hospital Morbidity Database (Data table). 

Minimal trauma hip fractures

Minimal trauma hip fracture is one of the most serious and debilitating outcomes of osteoporosis [4]. 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 the community and the Australian health system [5].

In 2016–17:

  • there were 26,721 hospitalisations for minimal trauma hip fracture among people aged 50 and over
  • the rate of hospitalisation for minimal trauma hip fracture was more than twice as high for females (444 per 100,000 people) compared with males (208 per 100,000) (Figure 3)
  • hospitalisation rates were highest in those aged 85 and older (2,581 per 100,000 people, compared with 17 per 100,000 people aged 50–54).

Figure 3: Rate of hospitalisations for minimal trauma hip fractures, people aged 50 and over, 2016–17

The vertical bar chart shows the age-adjusted hospitalisation rates (per 100,000 population) for minimal trauma hip fracture increased with age and were highest among people aged 85 and over for both males (1,924) and females (2,975).

Source: AIHW National Hospital Morbidity Database (Data table). 

References

  1. 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.
  2. RACGP (The Royal Australian College of General Practitioners) 2010. Clinical guideline for the prevention and treatment of osteoporosis in postmenopausal women and older men. Melbourne: RACGP.
  3. NPS (National Prescribing Service) 2011. Reducing fracture risk in osteoporosis. Sydney.
  4. Ip TP, Leung J & Kung AWC 2010. Management of osteoporosis in patients hospitalized for hip fractures. Osteoporosis International 21 (Suppl 4):S605–S614.
  5. Watts JJ, Abimanyi-Ochon J & Sanders KM 2013. Osteoporosis costing all Australians: A new burden of disease analysis–2012 to 2022. Sydney: Osteoporosis Australia.