Background
Fractures may occur in patients on treatment for osteoporosis even if the treatment is being taken correctly and is working. The reason for this is that the risk of fractures is not only dependent on bone mineral density, which is increased by osteoporosis treatments, but also by the risk of falls. Non-vertebral, non-hip fractures are not uncommon in patients with osteoporosis and most clinical trials with most agents they were reduced by about 15-20% compared with placebo.
Clinical Evaluation
- If the patient is on oral bisphosphonates ensure that they are being taken on an empty stomach, with a large glass of water, leaving at least 30min before taking other medications or food and drink.
- If at least two years has elapsed since starting oral bisphosphonate, consider referring the patient for a repeat DEXA scan to assess if BMD has responded to treatment.
- No action is required in patients who have already commenced on a cycle of zoledronic acid for osteoporosis by secondary care. These individuals will be reviewed by the osteoporosis service.
- No action is required for patients under treatment with anabolic therapy. These individuals will be reviewed by the osteoporosis service.
- Consider checking for secondary causes of osteoporosis unless these have already been done.
M.A & S.R/H.B. 25-01-24
Indications for referral of patients who fracture on treatment to secondary care and who have had a repeat DEXA to assess response are shown below.
- Bone loss of >4% at any site on repeat DEXA despite adhering to oral bisphosphonate treatment.
- Progression of vertebral osteoporosis (height loss or new fractures) despite adhering to oral bisphosphonate treatment
