Postmenopausal Osteoporosis: Screening & Diagnosis based on FRAX® and BMD

@#Osteoporosis is a common ailment, especially in older women, yet it is one of the most under-diagnosed and undertreated diseases. Screening of patients, therefore, is invaluable to identify those who require further evaluation. We shall discuss who requires screening and further evaluation of osteoporosis and discuss the diagnosis of osteoporosis.

Postmenopausal Osteoporosis: Diagnosis, FRAX® and Management

@#Osteoporosis-related fractures are increasing at a rapid rate, especially in Asia due to the ageing population. This would result in increased morbidity and mortality of the seniors as well as creating a strain on the healthcare system. Efforts should be made to prevent osteoporosis, screen for osteoporosis early and timely treatment to reduce the risk of fractures. As falls are a major risk factor for fracture in osteoporotic patients, management of osteoporosis should include efforts to reduce falls. Using a population-wide strategy for women 65 years old couple with high-risk population screening using a combination of tools such as FRAX® and OSTA as well as clinical risk factors for women below 65 years old can detect osteoporosis early for intervention. Treatment options for osteoporosis include bisphosphonates, denosumab, teriparatide, raloxifene, menopausal hormone therapy and tibolone. Drug choices should be individualised to the patient, balancing the risk/benefit ratio.

APPROACH AND ASSESSMENT OF OSTEOPOROSIS: IDENTIFYING AND MANAGING RISK

With an ageing population, the incidence of osteoporoticfractures leading to deaths and impairment in quality oflife. However, despite the availability of effectivetreatments, osteoporosis is often under-diagnosed andunder-treated. Primary fracture prevention meansdetection of osteoporosis early with timely appropriatetreatment to improve the bone and lifestyle andenvironment optimisation to reduce falls. We propose apopulation-based combined with high-risk prescreeningfor measurement of bone mineral density (BMD) toreduce the incidence of fractures in the population.

Evidence-based medicine and quality assurance workshops for screening of osteoporosis as a teaching strategy in the residency training program in Family and Community Medicine at the UP-Philippine General Hospital

OBJECTIVE: This study aims to determine the effectiveness of Evidence-Based Medicine (EBM) and Quality Assurance (QA) lectures and workshops on osteoporosis screening as a teaching strategy in improving the current level of knowledge and appropriate care given by resident physicians of UP-PGH Department of Family and Community Medicine (DFCM) for adults at risk for osteoporosis. METHOD: A before-and-after educational intervention study was conducted within the residency training program of the UP-PGH DFCM. RESULT: A total of 28 resident physicians and 300 medical records of adult patients aged >50 years who were considered at risk for osteoporosis were include in the study. There was an overall significant increase in mean knowledge scores of resident physicians on osteoporosis after the four sessions. None of the medical records reviewed documented evaluation and screening for osteoporosis hence the appropriate standard of care was not achieved as a target. CONCLUSION: Evidence-Based Medicine and Quality assurance workshops conducted for resident physicians of UP-PGH DFCM were effective in improving the current level of knowledge in osteoporosis screening however they were not an effective strategy in improving the level of appropriate care provide for adult patients at risk for osteoporosis.