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The prevention and management of osteoporosis Consensus statement Australian National Consensus Conference 1996
OSTEOPOROSIS is a condition of low bone mass leading to greater bone
fragility and an increase in fractures, especially among older
Australians. It is a major cause of fractures, producing
considerable morbidity and mortality. The current cost to the
community of osteoporotic fractures among Australians over 60 years
of age is estimated at $779,000,000 annually. With an ageing population
the problem will grow dramatically unless successful strategies for
preventing and treating osteoporosis are devised.
To date, there has been little consensus on a number of issues relating
to the prevention and management of osteoporosis. The principal
indicator of the disease is bone density as measured by bone
densitometry, but the place of population or high-risk screening is
unclear, as is the role of alternative diagnostic tools such as
ultrasound. Hormone replacement therapy is first line treatment for
postmenopausal women, but its effects in the long term are not known;
the roles of bisphosphonates, calcitriol, calcium and exercise are
less certain. Little is known about effectively managing
osteoporosis in men. Falls prevention and some other risk factors for
fracture need to be addressed, as they may be as important as improving
bone density in preventing fractures.
After successful National Consensus Conferences in 1991 (on the
management of hyperlipidaemia) and 1993 (on the management of
hypertension), the Pharmaceutical Benefits Advisory Committee of
the Department of Health and Family Services decided to sponsor
another to address the prevention and management of osteoporosis.
The conference was held in Canberra on 23-24 October 1996 and was
supported by the Pharmaceutical Education Program. The co-sponsors
were the Australian and New Zealand Bone and Mineral Society, the
Australian Pharmaceutical Manufacturers' Association,
Osteoporosis Australia, the Australasian Menopause Society, the
Royal Australian College of General Practitioners, the Royal
Australasian College of Physicians and the Royal Australian College
of Obstetricians and Gynaecologists.
The objectives of the conference were to produce a consensus
statement that would:
At the conference, a faculty of speakers expert in preventing and
managing osteoporosis presented evidence to a Consensus Panel and
conference delegates. The Panel included experts in
osteoporosis-related fields, including epidemiology,
endocrinology, rheumatology, orthopaedics, obstetrics and
gynaecology, biochemistry, general practice, dietetics,
physiotherapy, and the consumer movement. The speakers were asked to
rate the strength of the evidence, from meta-analysis of all relevant
randomised controlled trials through to expert opinion. From this
evidence, the Panel drafted a statement as a set of answers to
questions posed to it by the organising committee. The draft
statement was then discussed and debated on the floor of the
conference, and the resulting amendments and additions were
considered for the final consensus statement.
The Consensus Statement is intended to guide medical practitioners
in preventing and managing osteoporosis. The continuing
uncertainty in many areas of prevention and management highlights
the need for further research.
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The Medical Journal of Australia
Commonwealth Department of Health and Family Services
This publication was funded through the Pharmaceutical Education Program, a Federal Government initiative to promote the quality use of medicines
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<URL: http://www.mja.com.au/>
©1997 Medical Journal of Australia.
