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Clinical guideline for the prevention and treatment of osteoporosis in postmenopausal women and older men

February 2010

Chronic diseases have a major impact on Australian society, accounting for about two-thirds of health care expenditure (more than $35 billion) in 2000 and 2001. An increasing proportion of the population has risk factors for, or at least one, chronic disease, leading to increasing public health costs. Health service policy and delivery must address not only acute conditions, but also effectively respond to the wide range of health and public services required by people with chronic illness. Strong primary health care policy is an important foundation for a successful national health delivery system and long term management of public health. It is also linked to practical outcomes including lower mortality, decreased hospitalisation and improved health outcomes. National strategic health policy has recently given increased recognition to the importance of chronic disease management, with Federal Government endorsement of a number of initiatives for the prevention or delay in onset, early detection, and evidence based management of chronic diseases, including osteoporosis (OP).

Osteoporosis exerts a significant burden on both individuals and the community. In terms of cost, it was estimated in 2001 that the combined direct and indirect cost of OP in Australia was approximately $7 billion annually. For further details refer to the Evidence to support the National Plan for Osteoarthritis, Rheumatoid Arthritis and Osteoporosis: Opportunities to improve health-related quality of life and reduce the burden of disease and disability.

Expiry date for the recommendations

This guideline presents a comprehensive review of pharmacological management of OP within the Australian health care context, based on the best available evidence up to September 2006. Specific additional literature searches covering the intervention options were conducted and publications considered important were included up to submission of the document to the National Health and Medical Research Council (NHMRC) in May 2009.

The guideline was approved by the CEO of the NHMRC on 5 February 2010, under Section 14A of the National Health and Medical Research Council Act, 1992. Approval for the guidelines by the NHMRC is granted for a period not exceeding 5 years. It is expected that the guideline will be reviewed, and revised if necessary, no less than once every 5 years. Review should be more frequent in areas where clinical practice or research is known to be changing rapidly. Readers should check with The Royal Australian College of General Practitioners (RACGP) website for any reviews or updates of this guideline.

The role of general practitioners

General practice plays an important role within the Australian health care system in the prevention, early detection and management of chronic disease. The nature of general practice provides the opportunity for early screening for chronic disease and enables preventable risk factors to be addressed. General practitioners have an important role in monitoring disease progression and response to treatment, as well as managing comorbidities in conjunction with the treating specialist and other members of the multidisciplinary team. However, as seen across the health care system, OP is frequently under treated in general practice.5 This guideline is designed to provide clear, evidence based recommendations to assist GPs in managing patients with OP. The purpose of this guideline is to support clinical judgment, not to replace it.

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