NEWS 5
ausdoc . com . au 19 APRIL 2024
NEWS 5
Updated guidelines back FRAX tool
Associate Professor Peter Wong .
~ 9 / 10
Rachel Fieldhouse GPs are now advised to use the Fracture Risk Assessment tool to determine future risk of major osteoporotic fractures in postmenopausal women and men over 50 , according to updated guidance .
Endorsed by the RACGP , it states that patients should be referred for dual X-ray absorptiometry ( DXA ) if their fracture risk is ≥10 %, with the BMD result used to re-stratify their risk , while
ADVERTORIAL funded by MSD
COVID-19 related deaths Australian Bureau of Statistics ( ABS ) data : March 2020 – November 2023 Total deaths due to COVID-19 : 16,472
82 %
COVID-19 related deaths were in patients with a pre-existing chronic condition 10
deaths due to COVID-19 were in people aged ≥70 years 10
bisphosphonates can be used as first-line therapy for osteopenia .
The guidelines include 45 recommendations for risk assessment , fracture prevention , pharmacotherapy and ongoing monitoring .
There is also a special issues section focusing on frail patients and over-75s , those receiving cancer treatment and
Treat your at risk patients for COVID-19 based on their risk factors for severe illness . Don ’ t wait for symptoms to progress 9-11
Age is the single biggest risk factor for COVID-19 death and hospitalisation ,
10 , 11 based on Australian data
Comorbidities also increase risk of COVID-19 death and hospitalisation ,
10 , 11 based on Australian data
Top 5 pre-existing chronic conditions certified with COVID-19 deaths 10
Chronic cardiac conditions 32 % Dementia 24 % Chronic respiratory conditions 15 % Cancer 14 % Diabetes 12 %
9 , 12 , 13
Early testing and treatment of at-risk patients is crucial
‘ We need some patients to jump on board and get treatment going .’
“ This is important , as like most antivirals ... time to initiation is perhaps the biggest determinant of how effective they are .”
Associate Professor Paul Griffin ,
Infectious Diseases Specialist , Microbiologist and Researcher Source : Personal communication , 2 September 2023 those with medication-related osteonecrosis of the jaw .
Associate Professor Peter Wong , chair of the guidelines review committee , says “ a lot has changed ” in the update , with the advice on using the Fracture Risk Assessment tool
( FRAX ) based on GP feedback . “ It is quite a useful absolute risk fracture calculator because it
References : 1 . LAGEVRIO Product Information . October 2023 . 2 . Pharmaceutical Benefits Scheme . www . pbs . gov . au ( accessed March 2024 ). 3 . Gentry CA et al . J Infect 2023 ; 86 ( 3 ): 248 – 255 . 4 . Lin DY et al . JAMA Netw Open 2023 ; 6 ( 9 ): e2335077 . 5 . Park HR et al . Infect Chemother 2023 ; 55 ( 4 ): 490 – 499 . 6 . Van Heer C et al . Lancet Reg Health West Pac 2023 ; 41:100917 . 7 . Paxlovid ( nirmatrelvir-ritonavir ) Product Information . February 2024 . 8 . University of Liverpool . COVID-19 Drug Interaction Checker . Available at https :// www . covid19-druginteractions . org / checker ( accessed March 2024 ). 9 . Australian Government Department of Health and Aged Care . Oral treatments for COVID-19 . https :// www . health . gov . au / topics / covid-19 / oral-treatments ( accessed March 2024 ). 10 . Australian Bureau of Statistics . COVID-19 Mortality in Australia : Deaths registered until 30 November 2023 . ( 20 December 2023 ). Available at https :// www . abs . gov . au / articles / covid-19-mortality-australia-deaths-registered-until-30-november-2023 ( accessed January 2024 ). 11 . Australian Government Department of Health and Aged Care . Communicable Diseases Intelligence . COVID-19 Australia : Epidemiology Report 79 . Reporting period ending 24 September 2023 . 12 . Australian Government Department of Health and Aged Care . Testing for COVID-19 . https :// www . health . gov . au / topics / covid-19 / testing . ( accessed March 2024 ) 13 . Australian Government Department of Health and Aged Care . Testing positive for COVID-19 . https :// www . health . gov . au / topics / covid-19 / testing-positive ( accessed March 2024 ).
gives you the 10-year risk of hip fracture and major osteoporotic fracture ,” he says .
“ The Garvan Fracture Risk Calculator still has its uses because it contains an input for falls , whereas at the moment , FRAX does not .”
GPs can also consider bisphosphonates as first-line treatment for osteopenia and re-evaluate the need for continued therapy after 5-10 years for patients who respond well to treatment , have a BMD T-score of ≥-2.5 and have experienced no recent fractures .
“ Treatment should be restarted if there is bone loss — especially at the hip — or if a further minimal trauma fracture is sustained ,” the guidance states .
Professor Wong said it would be “ reasonable ” to reassess bone loss with DXA 2-3 years after a patient stopped bisphosphonate therapy or after a fall or fracture .
“ If someone fractures on standard therapy or shortly after cessation , then it is a prompt to think , ‘ Well , what is going on here ?’” he added .
The Sydney rheumatologist said the guidelines also clarified which patients were at ‘ imminent ’ or ‘ very high ’ risk of fracture and included a flowchart for risk assessment , diagnosis and management to guide GPs .
“ We really need some patients to jump on board and get treatment going , and we tried to identify that ,” he added .
“ If there is one thing a GP needs to read from this 160-page document , it is on page 13 , which is the flowchart , and we would suggest that you print it out — preferably in colour — and stick it to your desk or wall .”
While the definition of ‘ very high ’ risk was still being developed , the guidance says patients should receive a “ prompt specialist referral ” for recent fractures and other risk factors , such as corticosteroid use , a history of falls , rheumatoid arthritis or a FRAX major osteoporotic fracture score of ≥30 %.
Other updates included the addition of romosozumab for women at ‘ very high ’ risk of fractures , as well as the recommendation for menopausal hormone therapy or selective oestrogen receptor modulators to reduce fracture risk .
Vitamin D and calcium supplements were also only recommended for frail or institutionalised older patients and those taking osteoporosis treatments who have low serum vitamin D levels or a daily dietary calcium intake below 1300mg .
“ If you are well , ambulatory , community-dwelling , happy , hale and hearty , then calcium and vitamin D supplementation is probably not going to be that valuable for you ,” Professor Wong said .
RACGP : Osteoporosis management and fracture prevention in postmenopausal women and men over 50 years of age ; Mar 2024 .