Executive Summary

Executive Summary

This guide is an evidence update of the Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age, second edition, published in 2017 by The Royal Australian College of General Practitioners (RACGP).1 The accumulation of high-quality evidence supporting changes to clinical practice over the past five years, the need for expert consensus and opinion, and new developments in the pharmacological management of osteoporosis, especially the role of osteoanabolic therapies, prompted this revision.

This guide is designed to provide clear, evidence-based recommendations to assist Australian general practitioners (GPs) in managing patients over 50 years of age with poor bone health, including osteopenia and osteoporosis. Its purpose is to support clinical judgement making in the individual patient, not to replace it, and help busy GPs achieve better patient outcomes by the:

  • prevention of first fracture
  • early diagnosis of osteoporosis to allow prompt bone health management
  • identification of undiagnosed patients following a first fracture to prevent subsequent fractures
  • management of secondary causes of poor bone health.

This guide provides evidence-based recommendations, content and statements across key topics constituting best practice in the identification, diagnosis, prevention and treatment of osteoporosis.

Most recommendations in the previous (second) edition were based on critical analysis of published, peer-reviewed evidence from 2006 to 2016, following a systematic review of available evidence. Every section in this new edition has been reviewed and updated with current peer-reviewed evidence by a bone expert with particular subspeciality expertise in that topic. Focused literature searches were also undertaken in subject areas that the Guideline Review Committee felt needed particular attention. These included fracture risk assessment tools, the frequency of dual energy X-ray absorptiometry (DXA) monitoring, patients at ‘imminent’ or ‘very high’ fracture risk and pharmacological therapies. Where there was insufficient evidence available, or where the quality of the evidence did not meet minimum requirements (as described in Appendix A), recommendations were developed through Guideline Review Committee consensus cognisant of the complexities and time constraints of a busy GP. Details on the development process, how to use this guide and membership of the Guideline Review Committee are found in Appendices A, B and D.

Certain areas of osteoporosis management have evolved significantly since the second edition. Specifically, recommendations for the use of fracture risk assessment tools, particularly FRAX®, for screening, the risk of rebound vertebral fracture following denosumab cessation, the removal of strontium as a therapy, the clarification of ‘imminent’ or ‘very high’ fracture risk in patients, the importance of calcium and vitamin D status and the use of osteoanabolic therapies deserved special attention. A ‘Special issues’ section addresses updated recommendations on delayed dental healing and the management of bone health in patients undergoing androgen deprivation therapy for prostate cancer or aromatase inhibitor treatment for breast cancer.

Clin A/Prof Peter Wong PhD Grad Dip Clin Epi FRACP CCPU A/FRACMA
Chair, National Osteoporosis Guidelines Review Committee

  1. The Royal Australian College of General Practitioners. Osteoporosis prevention, diagnosis and management post-menopausal women and men over 50 years of age. 2nd edn. South Melbourne, Vic: RACGP, 2017.

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