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Osteoporosis Guidelines-What Your Doctor Should Be Doing

 Osteoporosis guidelines for testing are important because this is a “silent” disease.  That is, you wouldn’t know you had it until you break a bone.  While bone density tests allow doctors to detect it, there are no symptoms short of a broken bone or sharp pain.  That’s why there are osteoporosis guidelines.


These osteoporosis guidelines are for doctors.  However, if you are a patient, knowing what your doctor is supposed to do will help you know whether your physician is doing everything he or she can do to keep you from potentially deathly falls caused by osteoporosis.


Osteoporosis guidelines are for physicians who are advising patients 50 years of age or older, in particular post-menopausal women.  They are supposed to advise their patients about the risk for osteoporosis and recommend a bone density test, if appropriate.  In addition, they should evaluate patients for secondary causes of the disease.


Doctors following the osteoporosis guidelines will ensure that their patients are getting 1200 mg. of calcium a day and recommend supplements if that amount is not part of the patient’s daily diet.  Patients should also get 800 mg. of Vitamin D per day, including supplements if necessary.


They should suggest that their patients engage in weight-bearing and muscle strengthening exercises.  This decreases the risk of fractures from falls.


Doctors are supposed to discuss the risks of cigarette smoking and excessive alcohol use vis a vis osteoporosis risk.


In addition, there are several osteoporosis guidelines related to bone density testing.  All women over 65 and all men over 70 should get a baseline bone density test.  Additionally, patients aged 50 to 70 who have an osteoporosis risk profile should be tested.  A schedule for future testing should also be established, preferably every two years.


Osteoporosis guidelines say that doctors should begin treating patients with hip or vertebral (clinical or morphometric) fractures.  After appropriate evaluation, they should also begin treatment in patients in whom dual-energy x-ray absorptiometry (DXA) shows BMD T-scores of less than –2.5 at the femoral neck, total hip, or spine.


Additionally, they should begin treatment in post menopausal women and in men 50 years and older who have low bone mass which is also known as osteopenia.  That means those with a T-score of –1 to –2.5 at the femoral neck, total hip, or spine as well as those who have 10-year hip fracture probability of 3% or more or a 10-year all major osteoporosis–related fracture probability of 20% or more based on the US-adapted WHO absolute fracture risk model.


Currently, the Food and Drug Administration has approved pisphosphonates, calcitonin, estrogens, hormone therapy, raloxifene, and PTH 1-34 for treatment of osteoporosis.  These drugs should be discussed with patients, as appropriate.


Osteoporosis treatment is cost-effective in patients with fragility fractures or osteoporosis, in older individuals at average risk, and in younger persons with additional clinical risk factors for fracture.  So, there is no excuse for sloppy diagnosis.  If you are a patient over 50 years of age, make sure that your doctor is following these osteoporosis guidelines.


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