Bone Health Assessment (more)

Resources for the Comprehensive Geriatric Assessment based

Proactive and Personalised Primary Care of the Elderly

Bone Health Assessment

The two phases of bone loss :

There are two phases of bone loss in women:

The first phase occurs predominantly in trabecular bone and starting at menopause.

This phase could be defined as menopause-related bone loss.

After 4-8 years, the second phase exhibits a persistent, slower loss of both trabecular and cortical. bone, and is mainly attributed to reduced bone formation.

This is age related bone loss, which is the only phase that also happens in men.

During the menopausal transition period, the average reduction in BMD is about 10%.

Approximately half of women are losing bone even more rapidly, perhaps as much as 10%-20% in those five to six years around menopause.

About 25% of postmenopausal women can be classified as fast bone losers, and they could be discovered by the measurement of bone loss and bone resorption markers.

Osteoporotic fractures take place in temporal sequence, with the first sign being fractures of the lower end of radius starting at age 50 years, followed by vertebral fractures at age 60-75 years and hip fractures beginning in the late 70s.

Investigations :

DXA scanning to assess bone mineral density is useful in patients with a high FRAX/QF score to determine if treatment for osteoporosis is indicated.

Previous fragility fractures can be sufficient to diagnose osteoporosis without DXA.

Urea & Electrolytes, Calcium, Phosphate, Alkaline Phosphatase, Thyroid Function.

Consider 25-OH Vitamin D if clinical evidence of osteomalacia.

(NB Serum Vitamin D levels can be difficult to interpret and there is controversy about replacement doses).
Supplementation in patients with osteoporosis, without checking serum levels is acceptable, is acceptable in individuals at high risk of low vitamin D, or housebund or resident in a care home, or with established osteoporosis.

Where adequate dietary calcium is ensured, supplementation with vit D alone is acceptable.

What investigations follow FRAX ?

Many people confuse the results of FRAX with the recommendations for treatment based on the results.

The FRAX does the best job available for predicting fractures, but it can't tell if a treatment will safely reduce the fracture rate or not. That will depend on other factors such as the underlying diseases, allergies, risks of medicines, interactions with other medicines, cost, and safety.