Screening for Osteoporosis

The Red Book suggests that osteoporosis screening should be guided by an individual’s risk factors. It doesn’t recommend universal screening for osteoporosis in all adults. Instead, it suggests a targeted approach to identify those who might benefit most from interventions.

  1. Risk Assessment: Factors such as
    1. older age,
    2. history of minimal-trauma fractures,
    3. long-term use of glucocorticoids (>7.5mg Prednisolone daily for > 3/12),
    4. low body weight,
    5. smoking,
    6. heavy alcohol use,
    7. family history of hip fractures, and
    8. other medical conditions can increase the risk of osteoporosis (ie Lithium)
  2. Who Should be Screened:
    1. The guidelines suggest considering a DEXA scan for postmenopausal women and men aged 50 and over with one or more risk factors for osteoporosis, or for younger people with several risk factors.
    2. A one off DEXA scan at 70 with repeats every 5 years for normal scan results (T score > -1.0)
  3. Fracture Risk Assessment Tool (FRAX): In some cases, tools like FRAX may be used to estimate a person’s 10-year risk of major osteoporotic fracture, which can help to guide decisions about treatment.
  4. Frequency of Screening: The frequency of BMD testing is usually individualized
    1. T score > -1.0 every 5 years (normal)
    2. T score -1.0 -> -2.5 every 2 years (osteopaenia)
    3. T score < -2.5 annually (osteoporosis)

Fracture Risk Tools

  1. Garvan: https://fractureriskcalculator.com.au/calculator/
  2. FRAX (UK) https://frax.shef.ac.uk/FRAX/tool.aspx?country=31

Medical Conditions Associated with Osteoporosis

  1. Endocrine Disorders: Conditions such as hyperparathyroidism, hyperthyroidism, Cushing’s syndrome, and diabetes mellitus can impact bone density and health.
  2. Rheumatologic and Inflammatory Diseases: Rheumatoid arthritis, systemic lupus erythematosus, and other chronic inflammatory diseases are associated with an increased risk of osteoporosis.
  3. Gastrointestinal Disorders: Conditions affecting nutrient absorption, like celiac disease, inflammatory bowel disease (Crohn’s disease and ulcerative colitis), and gastric bypass surgery, can lead to deficiencies in calcium and vitamin D, crucial for bone health.
  4. Hematologic Disorders: Blood disorders such as multiple myeloma and other myeloproliferative diseases can affect bone marrow and bone integrity.
  5. Chronic Kidney Disease: Impaired kidney function can affect vitamin D, calcium and phosphate balance, impacting bone metabolism.
  6. Chronic Liver Disease: Liver diseases, including cirrhosis, can disrupt the metabolism of vitamin D and hormones that regulate bone health.
  7. Nutritional Disorders: Conditions like anorexia nervosa or bulimia, where there is inadequate intake or absorption of key nutrients, can weaken bones.
  8. Genetic Disorders: Certain genetic conditions, such as osteogenesis imperfecta, are direct causes of osteoporosis.
  9. Respiratory Diseases: Chronic obstructive pulmonary disease (COPD) and cystic fibrosis have been linked to higher osteoporosis risk.
  10. Neurological Disorders: Parkinson’s disease, multiple sclerosis, and other conditions affecting mobility can lead to decreased bone density due to reduced physical activity.
  11. Cancer: Certain cancers, especially those affecting the bone marrow, can lead to osteoporosis. Also, treatments for cancer, like chemotherapy and hormonal therapy, can affect bone health.
  12. HIV/AIDS: HIV and its treatments can impact bone density.
  13. Long-term Use of Certain Medications: Prolonged use of glucocorticoids, anticonvulsants, proton pump inhibitors, and other drugs can contribute to bone loss.
  14. Hypogonadism: Low levels of sex hormones, such as estrogen and testosterone, are a significant risk factor for osteoporosis.

These conditions can lead to osteoporosis through various mechanisms, including direct effects on bone metabolism, nutritional deficiencies, hormonal imbalances, and reduced physical activity.

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