Osteoporotic fractures are major cause of disability and death. If we want to effectively prevent them, we should treat individuals at high risk of fracture. Primarily, we treat patients after osteoporotic vertebral or hip fracture, where it is required only to exclude secondary causes of osteoporosis prior to initiating treatment. For other women after menopause, the risk of fracture could be assessed using clinical factors, which are entered into the computer-driven FRAX algorithm. The measurement of bone mineral density could also be used, but we have to take into account the age and sex of subjects when interpreting the result. Treatment of osteoporosis requires a healthy lifestyle without smoking and excessive alcohol intake. The diet should be rich in calcium and protein. Regular physical exercise has positive effects on the bone as well as on the muscles and fall prevention. The addition of vitamin D is always recommended. Drugs have proven efficacy against osteoporotic fractures. We can choose between several inhibitors of bone resorption, such as estrogens, biophosphonates, raloxifene and denosumab. Teriparatide is an anabolic drug that promotes bone formation, while strontium ranelate has a beneficial effect on both processes of bone turnover.
F.18 Transfer of new know-how to direct users (seminars, fora, conferences)
COBISS.SI-ID: 4635711Recent survey amongst trauma surgeons in Slovenia showed that after an osteoporotic hip fracture only a small minority of the respondents would prescribe (6 %) or recommend (17 %) any kind of treatment for osteoporosis to their patients. To improve efficiency of care after hip fractures the national recommendations were written and adopted by the Board for Surgery at the Ministry of Health in 2011. Recommendations: Hip fracture after a fall from a standing height is equivalent to osteoporosis and DXA is not needed for the diagnosis. Every trauma department in the coun- try should have a registered nurse (RN) who acts as a dedicated coordinator, screens and educates patients or their relatives. She is responsible that basic laboratory studies are done for the assessment of osteoporosis. All eligible patients after a hip fracture should start with vitamin D3 2000 IU daily and 500 mg of calcium supplement daily before the discharge. The discharge letter should include the diagnosis of osteoporosis with fracture, instructions for additional laboratory tests to be done if needed and a clear recommendation that medical treatment should be introduced. After the discharge RN from the trauma department should get in contact with general physician, physiatrist or any other medical doctor who takes care of the patient via phone and check if everything was done according to the instructions in the discharge letter. Oral bisphosphonates are regarded as the first line treatment, while denosumab is reserved for patients over 70 years old and zoledronic acid is given to patients who cannot tolerate any other drug. If hip fracture was sustained when on appropriate treatment patient could be put on teriparatide
F.18 Transfer of new know-how to direct users (seminars, fora, conferences)
COBISS.SI-ID: 607395