Practice Guideline - Osteoporosis
Osteoporosis-related fractures occur in 50% of post menopausal women
during their lifetimes, 25% will develop a vertebral deformity and 15% will
suffer a hip fracture. Osteoporosis in men is being increasingly recognized.
In response to this MCI endorses the following recommendations:
Who to Screen (CMS
approved indications):
- All women over age 65.
- Any woman with estrogen deficiency.
- Any Man or Woman on steroid therapy
for greater than 3 months.
- Any Man or Woman with
hyperparathyroidism.
- Any Man or Woman with x-ray evidence
of osteopenia.
- Any Man or Woman with a non-traumatic
fracture (hip, vertebra, wrist)
- Any Man or Woman on osteoporosis drugs
to evaluate efficacy.
Response to Positive Screening Test:
- Patients with osteoporosis should have
treatment.
- Repeat bone density in 1-2 years.
- Patients with osteopenia should have
treatment based on risk factors.
Osteoporosis Risk Factors:
| PRIMARY |
SECONDARY |
|
|
- Dietary deficiency of
calcium or Vit. D
|
- Weight less than 55
Kg.
- Current smoking
- Previous Fracture
|
- ETOH abuse
- Excess Thyroid
Hormone
- Anticonvulsants
therapy
|
- Family history of
osteoporosis
|
|
Work-up for Secondary Causes of
Osteoporosis:
- Serum Calcium, Phosphorus,
Alk. Phos., SGOT, Creatinine, TSH, 25-Vit. D. Intact
PTH, 24-hour urine Calcium, (Testosterone level in
men)
References:
- AACE 2001 Guideline for
Management of Osteoporosis. Endocr Pract. 2001;7(No.
4)
- USPSTF Recommendation:
Screening for Osteoporosis. On line at:
www.ahcpr.gov/clinic/3rduspstf/osteoporosis/osteorr.htm
Variation from this guideline is always
acceptable if, in the opinion of the attending
physician, individual circumstances require it. |
