Osteoporosis

Description

General Measures

Medicine Treatment

Referral

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ICD-10 Code: M80.00-59/M80.80-99/M81.00-69/M81.80-99/M82.00-19/M82.80-89

DESCRIPTION

A disease characterised by low bone mass and micro-architectural bone deterioration leading to bone fragility and increase in fracture risk.

GENERAL MEASURES

Prevention

• Adequate energy and protein intake.
• Adequate dietary calcium intake (>1 g/day) particularly in the young, in breastfeeding mothers and in the elderly. This is preferably obtained from a dietary source.
• Weight bearing exercises, e.g. brisk 30 minute walk 3 times a week.
• Smoking cessation.
• Avoid excessive alcohol intake - >2 units daily has a 40% increased risk of sustaining any osteoporotic fracture, compared to people with moderate or no alcohol intake.
• Avoid falls.

LoE:III³⁴

MEDICINE TREATMENT

Primary prevention

In the institutionalised frail elderly patients, supplementation with calcium and vitamin D may reduce the incidence of hip fractures:

LoE:III³⁵

• Calcium, elemental, oral, 1 000 mg daily.

AND

• Vitamin D (Calciferol), oral, 800 units daily or 50 000 IU of Calciferol every 4 weeks.

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Note
Routine supplementation with calcium and vitamin D marginally increases the risk of myocardial infarction and stroke and is of unclear benefit in other populations.

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LoE:I³⁶ 

For glucocorticoid-induced osteoporosis, i.e. patient on long-term (>3 months) corticosteroids at doses ≥5 mg/day: M81.80-M81.89

LoE:I³⁷

• Bisphosphonates, e.g.:
  • Alendronic acid, oral, 70 mg weekly, for a maximum duration of 5 years.
    - Taken with a full glass of water, 30 minutes before breakfast – do not lie down.

Secondary prevention

Secondary prevention of osteoporotic fracture:

In severe osteoporosis, i.e. patients who have a T-score of –2.5 (severe osteoporosis) plus an osteoporotic fracture:

LoE:I³⁸

• Bisphosphonates, e.g.:
  • Alendronic acid, oral, 70 mg weekly, for a maximum duration of 5 years.
    • Taken with a full glass of water, 30 minutes before breakfast - do not lie down.

Supplement bisphosphonate therapy with:

• Calcium, elemental, oral, 1 000 mg daily.

AND

• Vitamin D (Calciferol), oral, 800 units daily.

Hormone replacement therapy

• See Menopause and Perimenopausal Syndrome.
• Only indicated early in menopause, if vasomotor symptoms are significant.
• Review contra-indications before initiating therapy.

REFERRAL

• Initial assessment. Initiation of, and monitoring response to, therapy, and 18–24 monthly bone mineral density (BMD), where required
• Fractures suspected to be due to osteoporosis for consideration for bisphosphonates.
• Patients not tolerating oral bisphosphonate.
• Patients with eGFR <30 mL/minute.

Click here for the Erratum to the Adult Hospital level STGs and essential medicine list 2019 5th edition

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2024 Edition