 Osteoporosis affects millions of Americans, yet it remains underdiagnosed and undertreated. The fractures associated with osteoporosis, particularly of the hip, spine and wrist, can have a significant impact on mobility, independence and quality of life. For primary care clinicians, recognizing patients at risk creates an opportunity to help prevent fractures before they occur. Primary care clinicians are well positioned to identify risk early, encourage appropriate screening and help patients take practical steps to protect their bone health. Who may be at risk?Age is an important factor, but it isn't the only one. Previous fractures, long-term steroid use, some cancer treatments, and conditions such as rheumatoid arthritis or celiac disease can also increase a patient's risk. Bone mineral density testing is generally recommended for women age 65 and older and men age 70 and older. Postmenopausal women under 65 should also be assessed for osteoporosis risk, with screening recommended for those found to be at increased risk. Men ages 50–69 should be considered for testing when risk factors are present, such as low body weight, a previous fracture, use of medications associated with bone loss, or certain medical conditions. A fracture after a relatively minor fall or injury, sometimes called a fragility fracture, is an important signal. In adults over 50, it should prompt clinicians to consider osteoporosis and future fracture risk, rather than viewing the fracture as an isolated event. Looking beyond the bone density scoreBone mineral density testing can help identify osteoporosis, but it is only part of the picture. Clinicians should also consider factors such as age, previous fractures, family history, medication use and other conditions that affect bone health. Tools such as FRAX® can help estimate a patient's future fracture risk and support treatment decisions. FRAXplus® can further refine this assessment by considering additional factors, such as how recently a fracture occurred, falls in the previous year, higher exposure to oral steroids and the duration of type 2 diabetes. For patients at particularly high risk, including those with recent or multiple fractures, specialist input may be appropriate. Want to build greater confidence assessing common musculoskeletal conditions in primary care? Explore JOF’s MSK Fundamentals online mini-course. Helping patients understand treatmentSeveral effective medications are available to reduce fracture risk. Bisphosphonates, including alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), and zoledronic acid (Reclast), are commonly used to treat osteoporosis. Other options include denosumab (Prolia). For some patients at very high fracture risk, bone-building medications such as teriparatide (Forteo), abaloparatide (Tymlos), or romosozumab (Evenity) may be appropriate. The right treatment depends on the patient’s individual risk, medical history, and preferences. Concerns about side effects can sometimes lead patients to delay, avoid or stop treatment. Primary care clinicians can help by listening to those concerns, putting potential risks and benefits into context, and helping patients make informed decisions about their care. It is also important for patients to understand that osteoporosis treatment may change over time. Some medications require careful planning when they are stopped or changed, so patients should be encouraged not to interrupt treatment without first discussing it with their healthcare provider. Don't overlook the basics Medication is only one part of protecting bone health. Depending on the patient’s needs, clinicians can also encourage:
A quick reminder for your next patientOsteoporosis may not cause obvious symptoms until a fracture occurs. That's why recognizing risk before that first, or next, fracture matters. When you're seeing a patient who may be at increased risk, consider asking: Have they been screened? Have they had a previous fracture? Are there other factors that put their bone health at risk? A few simple questions can help identify patients who may benefit from further evaluation, and create an opportunity to reduce their future fracture risk. Ready to strengthen your MSK skills? Continue your learning with JOF’s MSK Fundamentals online mini-course. References
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AuthorsWe're the staff and volunteers at Jackson Orthopedic Foundation, committed to improving the lives of patients with musculoskeletal conditions through education, research and service. Archives
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