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Guidelines for preventive activities in general practice 7th edition

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Full index

Introduction and user guide

Preventive activities before pregnancy

Genetic counselling and testing

Preventive activities in children and young people

Preventive activities in middle age

Preventive activities in older age

Communicable diseases

Prevention of chronic disease

Prevention of vascular and metabolic disease

Early detection of cancers

Psychosocial

Oral hygiene

Glaucoma

Urinary incontinence

Osteoporosis

Screening tests of unproven benefit

References

Appendices

Glossary

Acronyms

Acknowledgements

Disclaimer

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Osteoporosis

Osteoporosis age range table
Age 0 - 9 10 - 14 15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 79 >80
Women                 X X X X X X X
Men                   X X X X X X

Women aged 45 years and over and men from 50 years of age should have their risk factors for osteoporosis and fracture assessed (C). Screening by bone mineral densitometry should only be conducted in women over 65 years of age or in men or women over 60 years of age whose BMI is less than 20 kg/m2 (B).423-426

Osteoporosis: risk
Who is at higher risk of osteoporosis? What should be done? How often? Level of evidence and references
Average risk
  • Women 45 years of age or over
  • Men 50 years of age or over*


Assessment for risk factors Preventive advice
Every 12 months
I A (Women) 463
V C (Men)
High risk
  • Postmenopausal women over 65 years of age
  • Those over 45 years of age who sustain a low trauma fracture
  • Postmenopausal women with suspected vertebral fracture or major risk factors
Bone mineral densitometry Management of risk factors
At presentation and every 2 years
II B

Osteoporosis: intervention
Intervention Technique References
Assessment of risk factors Take a thorough history paying particular attention to:
  • previous low trauma fracture, osteopenia/vertebral deformity, loss of height (>0.5 cm/year), thoracic kyphosis
  • age (women 65 years of age or over), menopause (especially premature), maternal history of hip fracture, low body weight (BMI <19), immobilisation
  • medical conditions*: current or past history of corticosteriod therapy (prednisolone >7.5 mg/day for ≥6 months, or equivalent), eating disorders associated with low body weight, chronic liver or renal disease, malabsorption, primary hypogonadism, amenorrhea >12 months before 45 years of age, inflammatory arthropathies (eg. rheumatoid arthritis or thyroxine excess)
  • lifestyle factors: poor diet, limited sun exposure
  • falls risk (see Chapter 5.1 Falls and physical activity)

* Risk factors which apply particularly to men are: hypogonadism, glucocorticoid use, excess alcohol, multiple myeloma, conditions associated with thyroxine excess and primary hyperparathyroidism

 464
Preventive actions

Provide advice regarding risk factor modification, especially a good general diet high in calcium (1000–1500 mg/day) and vitamin D, adequate levels of physical activity, smoking cessation and limited alcohol and caffeine intake

Counsel patients regarding falls prevention – involving family and community agencies may be appropriate

Offer modest calcium with vitamin D supplements to those with poor diet and limited sun exposure

 
Bone mineral densitometry Bone density measured at the femoral neck by dual energy X-ray absorptiometry (DXA) is the best site for prediction of hip fracture 463,465

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© The Royal Australian College of General Practitioners
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