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Osteoporosis |
Northumberland osteoporosis guidelines
Osteoporosis risk factor scoring
Risk of fracture increases by 2-3 if bone density more than 1sd from mean. 10% of women and 50% of men have a secondary cause.
Adequate calcium intake is 800mg/day (1500mg/day post menopausal) but most adults only achieve 500mg/day. Calcium supplementation amy be useful when dietary intake is low and physical activity high. It is not a substitute for HRT postmenopausally, but may have a small place in the prevention of hip (not vertebral) fractures. Chewable or effervescent tabs give most reliable absorption. 2 pints of milk contain 1500mg calcium.
Relative risk of skeletal sites can be predicted: 1sd decrease in bone mineral density increases
DXA results are reported as T scores (comparison with the young adult mean) and Z scores (comparison with reference values of the same age). The T score relates to absolute fracture risk whereas the Z score related to the individual’s relative risk for their age. The table below shows a simple classification of DXA results and guidance for management:
| T score (WHO standard reference) | Fracture Risk | Action |
| Normal T > -1.0 | Low | Lifestyle advice |
| Low bone mass (osteopenia) T –1.0 to –2.5 | Above average | Lifestyle advice. HRT especially in women aged 50 – 60 years. Calcium and vitamin D supplementation. |
| Osteoporosis T< -2.5 Treat |
High | Lifestyle advice Calcium and vitamin D supplementation |
| Established osteoporosis T < -2.5 plus one or more fractures | Very high | Lifestyle advice. Pain control. Exclude secondary causes. Treat (see below). Calcium and vitamin D supplementation. Consider referral. |
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*Below the young adult mean.
In white women
older than 50 years.
2.5 SD 
–2.5