Managing Osteoporosis: Treatment Overview

 

Counselor,

Osteoporosis is a significant problem among older adults, with up to a 90% prevalence among nursing home residents. Fractures are the main burden associated with osteoporosis, with more than 2 million fractures occurring in the United States in 2005. Of those who sustain a hip fracture, up to 75% require nursing home placement for rehabilitation or long-term care. Many of the remainder receive home health care, resulting in over 2 million home health care visits for posthospitalization fracture care annually.


A history of a prior fracture in nursing home and home health patients makes intervention even more compelling given the exceedingly high risk for a second fracture. The occurrence of a fragility fracture negates the need for bone densitometry, because, at that point, the diagnosis of osteoporosis can be assumed. Thus, current guidelines recommend osteoporosis treatment for all persons with a history of a hip or vertebral fracture. However, osteoporosis remains underdiagnosed and undertreated in nursing home residents and community-dwelling senior adults. Osteoporosis medications reduce the risk of fracture in senior adults, but therapy is given to only 10-20% of nursing home residents with osteoporosis or a recent fracture. The use of calcium and vitamin D in this population is higher, but the doses provided may not be sufficient based on current recommendations.

The gap between treatment guidelines and current quality of care is the basis of our algorithm for the assessment and care of nursing home and home health care patients with a prior fracture. This report discusses the literature supporting these recommendations.

Treatment Overview

An initial laboratory evaluation of renal function, serum calcium, and alkaline phosphatase levels is the first step in evaluating a person with a prior fracture for possible osteoporosis treatment. These tests both screen for possible secondary causes of low bone mass or fracture while providing baseline information for deciding on a treatment option. Other lab tests may be helpful and are listed under supplemental lab tests. Vitamin D insufficiency in this population is highly prevalent. Serum 25-hydroxyvitamin D should be assessed, and, if not feasible, empirical treatment could be offered.

If clinically indicated, additional lab tests (eg, serum albumin to correct serum calcium) should be ordered. Thereafter, calcium and vitamin D therapy, fall risk assessment, and weight-bearing exercise is recommended. A dual x-ray absorptiometry (DXA) scan provides further information; however, the inability to obtain a DXA scan should not hinder management. Once osteoporosis therapy is started, adherence to and tolerance of the therapy should be monitored regularly and adjusted if indicated.

This article discusses many of the most effective osteoporotic treatments and can be viewed Here.

Retain Medical Experts with Indox Consulting


Indox Consulting provides access to board certified physicians practicing in all specialties nationwide. Our medical professionals can review your case in a timely, cost effective fashion and support your case through trial with authoritative analysis, affidavits and compelling testimony.

Call us to discuss your case today.

 
 
 
Personal Injury/General Negligence | Complex Business Litigation | Medical Malpractice | Employment Law | Intellectual Property | Class Action
Municipal Law | Business Transactions | Banking and Lending | Commercial and Business Litigation | Media and eCommerce Law
Arbitration and Mediation | Family Law | Estate Planning and Probate