GPs need to become champions for osteoporosis treatment

Professor Peter Ebeling

OSTEOPOROSIS treatment represents a missed opportunity for medical practitioners, according to the authors of a narrative review published in yesterday’s Medical Journal of Australia.

Only a small percentage of patients presenting to the health care system with minimal trauma fractures are being investigated or treated for osteoporosis, despite it affecting 1.2 million Australians.

Associate Professor Frances Milat and Professor Peter Ebeling from Monash University and Monash Health wrote that “there is a major gap between evidence and treatment in secondary fracture prevention, with fewer than 20% of patients presenting with a minimal trauma fracture being treated or investigated for osteoporosis”.

Associate Professor Fran Milat

Osteoporosis treatment is recommended in patients with a high absolute fracture risk.

“This includes older Australians (post-menopausal women and men aged over 60 years) with T scores £ -2.5 at the lumbar spine, femoral neck or total hip, and patients with a history of a minimal trauma fracture,” the authors wrote.

There are a growing number of effective therapies for osteoporosis for which the benefits far outweigh the risks.

Two are antiresorptive drugs, which decrease the number, activity and lifespan of osteoclasts, and teriparatide, which stimulates osteoblast recruitment and activity. There are also newer anti-osteoporosis drugs in clinical development.

In addition, non-pharmacological therapies such as calcium and vitamin D, exercise and fall reduction strategies can help prevent osteoporosis.

The authors wrote that the time to close the gap between evidence and treatment is well overdue.

They concluded: “General practitioners also need to take up the challenge imposed by osteoporosis and become the champions of change, working with the support of specialists and government to reduce the burden of fractures caused by osteoporosis in Australia.”