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New guidelines encourage increased osteoporosis screening
Every man and woman in Canada older than 50 should exist screened for bone-weakening osteoporosis, co-ordinate to new guidelines aimed at preventing and treating os fractures as aggressively as heart attacks.
The guidelines, published this calendar week in the Canadian Medical Clan Journal, focus on people 50 and older with a history of "fragility fractures" — fractures that occur after minor falls, such as slipping on ice.
Fragility fractures account for eighty per cent of all fractures in women over historic period 50.
"At that place's a huge care gap in that many of these patients are not being assessed or treated for osteoporosis," said Dr. Alexandra Papaioannou, a professor of medicine in the sectionalisation of geriatric medicine at McMaster University in Hamilton and a co-writer of the guidelines.
According to the authors, fewer than xx per cent of women, and ten per cent of men, with a history of fragility fractures are treated to preclude further fractures.
Past contrast, 75 per cent of patients who have had a heart attack receive beta blockers to lower the risk of another 1.
"Nosotros're at the aforementioned phase that (eye attacks) and cardiac disease were 10 years ago," said Dr. Papaioannou.
"People don't think annihilation can be done once you've had a fracture. They'll frequently attribute the fracture to the fall, it'southward surgically repaired, and that'southward it. Or someone who has lost summit, and thinks it's normal aging, or their backs are curving over, may be having what we telephone call these silent spine fractures."
"People don't realize that once you've had a fracture you lot're at much higher take chances of having another fracture — information technology's two to ten times higher."
As many every bit x per cent of hip fracture patients will break another hip within a year, she said. "Hip fractures can outcome in loss of independence and death. It's a bad manner to die, it's very painful.
"Everybody over the historic period l should be assessed for their gamble factors for osteoporosis — men and women," she said. Osteoporosis may be seen as simply a woman'south upshot, but when men break their bones afterward 50, "that's the biggest marker that they need to be assessed," Dr. Papaioannou said.
People at depression chance can prevent or slow their risk for fracturing every bit they age with practise, calcium and vitamin D. The guidelines recommend daily doses of up to two,000 IU of vitamin D for those with osteoporosis.
The guidelines also say that drug therapy should be offered to people at high run a risk — those who take a 20-per-cent or greater chance of a major fracture over the side by side x years based on their bone density scores, historic period, a history of fractures, particularly spine and hip, steroid use and other risk factors.
One of the biggest osteoporosis drug classes are bisphosphonates. Final yr, about 7.iv million prescriptions for the drugs worth $391 million were dispensed past Canadian drugstores, according to prescription drug tracking firm IMS Health Canada.
Bisphosphonates have been linked with increased risks of atrial fibrillation, the most common heart rhythm disturbance that increases the risk of stroke, as well as an increased chance of fractures of the femur and necrosis of the jaw.
Some critics worry routine screening will expand the market for drugs that carry rare but potentially serious side effects.
"Y'all're essentially casting the net to attempt to become more people into a screening program, and some of them will inevitably be put on these drugs," said Alan Cassels, a drug policy researcher at the Academy of Victoria. "Those treatments, in the long term, are shown to have a level of risk."
High-hazard patients — those with previous fractures — may benefit from bisphosphonates, said Dr. Mahyar Etminan, of the Centre for Clinical Epidemiology and Evaluation and the department of medicine at the University of British Columbia.
"Unfortunately, due to high marketing mainly in the U.South., many women on these drugs are not high chance-patients and we know in women who have not had a previous fracture but but osteopenia (thinning of os) these drugs actually don't do much," he said.
A study published terminal month in the British Medical Journal showed that taking the drugs over five years increases the risk of esophageal cancer.
The absolute risk "is not big," Dr. Etminan said. "Bisphosphonates increase the adventure from one in one,000, to two in one,000 (patients)."
But, "The more than people are exposed to these drugs, the college the gamble of seeing these agin events," he said. "Then educating both clinicians and the public on these agin events is the key."
Co-ordinate to Osteoporosis Canada, osteoporosis causes lxx to 90 per cent of xxx,000 hip fractures annually; 23 per cent of patients who fracture a hip dice in less than a year.
Source: https://nationalpost.com/news/canada/new-guidelines-encourage-increased-osteoporosis-screening
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