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Osteoporosis treatment: a missed opportunity

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Minimal trauma fractures remain a major cause of morbidity in Australia, affecting one in two women and one in four men over the age of 60 years.1 Mortality is increased after all minimal trauma fractures, even after minor fractures.2 Hip fractures are particularly devastating, leading to decreased quality of life, increased mortality and loss of functional independence.3

Defining osteoporosis

Bone mineral density (BMD) is expressed in relation to either “young normal” adults of the same sex (T score) or to the expected BMD for the patient’s age and sex (Z score). Osteoporosis is defined as a T score ≤ 2.5 SDs below that of a “young normal” adult, with fracture risk increasing twofold to threefold for each SD decrease in BMD.4,5 A BMD Z score less than −2 indicates that BMD is below the normal range for age and sex, and warrants a more intensive search for secondary causes. Importantly, osteoporosis is also diagnosed after a minimal trauma fracture, irrespective of the patient’s T score.

Absolute fracture risk

Treatment for osteoporosis is recommended for patients with a high absolute fracture risk. This includes older Australians (post-menopausal women and men aged over 60 years) with…