Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age

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This guideline is an evidence update of Clinical guideline for the prevention and treatment of osteoporosis in postmenopausal women and older men, published in 2010 by The Royal Australian College of General Practitioners (RACGP).1 The accumulation of high-quality evidence supporting changes to clinical practice over the last six years, the need for expert consensus in areas of conflicting evidence or variable practice, and new developments in the pharmacological management of osteoporosis were important factors in the decision to undertake this revision.

The publication of new data on the prevalence of osteoporosis in Australia and the health and economic impacts of this disease has also highlighted the need to clarify and re-enforce clinical guidance for health professionals at the front line of osteoporosis management. A burden of disease analysis recently published by Osteoporosis Australia estimates that in 2012, 4.74 million Australians older than 50 years of age (66%) had poor bone health, including more than one million with osteoporosis.

By 2022, it is estimated that 6.2 million Australians older than 50 years of age will have osteoporosis or osteopenia, a rise of 31% from 2012. A similar increase in the rate of fracture, from 140,882 in 2012 to 183,105 in 2022, is anticipated if action is not taken to improve the diagnosis and management of osteoporosis.

In addition to its significant health and social burden, osteoporosis exerts considerable economic pressures on government. The total direct and indirect costs of osteoporosis and osteopenia in Australia were $2.75 billion in 2012. This total annual cost is predicted to reach $3.84 billion by 2022. Hip fractures constitute the major burden, costing nearly $800 million in 2012.2 Evidence shows that timely diagnosis and appropriate pharmacological management reduces fracture rates.

However, osteoporosis remains significantly underdiagnosed and inadequately managed in Australia. Less than 20% of patients presenting to healthcare services with minimal trauma fractures are investigated or treated for osteoporosis.

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