Position Statement on the Management of Osteoporosis

Osteoporosis Australia (OA) now known as Healthy Bones Australia hosted a National Forum in 2019 with leading Australian clinical experts to develop a Position Statement on the management of osteoporosis. The purpose of this Position Statement is to provide GPs with clear guidance concerning the identification, investigation and treatment of persons at risk for fragility fractures.

Despite the publication of the 2017 RACGP/OA Guidelines ‘Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age’ there is persisting under-investigation and undertreatment of patients at risk for fracture, even those with existing minimal trauma fractures. This Position Statement provides an expert opinion-based guidance for osteoporosis management complementing the current 2017 RACGP/OA Guidelines and will be circulated nationally.

Key messaging for GPs

1. Osteoporosis is a chronic disease and like other chronic diseases needs long-term treatment over a lifetime in most cases.
2. If osteoporosis treatment is interrupted in patients attaining a lower fracture risk, patients must be reviewed with bone density tests, bone remodelling markers and clinical follow-up for new fractures or emerging causes for bone fragility. Bone loss will eventually restart and the benefits of treatment will be lost.
3. There is no treatment interruption with denosumab, as its effects are rapidly reversible. If, for whatever reason denosumab treatment cannot be continued, transition to an oral bisphosphonate for at least 12 months is recommended, commencing within 4 weeks of the missed dose.
4. In all Australians aged >70 years and in most Australians aged >50 years with a fragility fracture, a bone density test is recommended.
5. If a patient has a fracture during treatment this may indicate a need to change therapy, specialist consultation may be required.
6. The transition from denosumab to the anabolic drug, teriparatide, may be associated with bone loss.
7. A BMD T score ≤-2.5 is diagnostic of osteoporosis and bone fragility. However, in younger patients with a T score of ≤-2.5, the absolute fracture risk may not exceed the intervention threshold.
8. As fracture risk also depends on age and other clinical risk factors (e.g. glucocorticoid use) in addition to the BMD T score, an absolute fracture risk calculator (FRAX® or Garvan) is useful to calculate this risk over the next 5 or 10 years. If the 10-year risk of any fragility or hip fracture is >20% or >3%, respectively, treatment is recommended.

Download the full report.