Mount Carmel Health Partners Clinical Guidelines Osteoporosis

Osteoporosis Clinical Guideline Definition: Osteoporosis is a multifactorial skeletal disease characterized by low bone mineral density with micro-architectural disruption and skeletal fragility resulting in decreased bone strength and an increased risk of fracture. Causes: Osteoporosis is the result of an inadequate intake of calcium and vitamin D, lack of weight-bearing exercise, and/or lack of estrogen. It is also associated with hormonal disorders like hyperparathyroidism or chronic diseases that interfere with mobility. Certain medications, such as glucocorticoids, can also induce osteoporosis. Quick Guide to Osteoporosis Care • Diagnosis should be made by a bone minerals density (BMD) test. • Patients should be tested and treated for secondary causes of osteoporosis (see Table C). • Treatment includes lifestyle modification and bisphosphonates as first-line medication. • If the patient has a fragile fracture, osteoporosis treatment is indicated even if the BMD test results are normal. • Treatment should also continue even if follow-up BMD test results are normal after 1 to 2 years of treatment. Evaluation Treatment Has patient had a vertebral, hip/femur, or other fragility fracture? No Is the patient a woman aged 65 or over? Does the patient have risk factors for osteoporosis? (see Table D) No No Yes Yes Yes Obtain a BMD measurement if more than 2 years since last done Is the patient currently on medication to treat osteoporosis? Yes No Obtain a BMD measurement if more than 2 years since last done Obtain additional labs: • Biochemistry profile • 25-hydroxyvitamin D • Complete blood count • TSH Were the lab results normal? Yes Yes Was the BMD measurement below normal? (see Table B) No Encourage lifestyle modifications. Prescribe appropriate medications. (See Treatment Recommendations, Page 2) No Treat secondary causes (see Table C) Continue yearly assessment of medications and lifestyle modifications. Obtain a follow-up BMD measurement after 1 to 2 years of treatments. Continue to assess the patient yearly for risk factors. July 2017