CardiovascularNepean Consensus Statement Meeting: Treatment For Osteoporosis In Institutionalised Older People In Australia
Leading Australian bone and geriatric specialists have hailed the Nepean Consensus Statement meeting on the treatment of osteoporosis in the aged care setting a major success, and a significant step forward in addressing this growing national issue.
Osteoporotic fractures are an important cause of morbidity and mortality in residential aged care facilities. While those in the aged care setting are at greater risk of osteoporotic fractures compared to those in the wider community, osteoporosis continues to go under-diagnosed and undertreated, signifying a genuine need for the Nepean Consensus Statement Meeting.
Held on 25th July, invited delegates, which also included GPs and nurses, developed consensus recommendations outlining best management practice for the prevention of osteoporotic fractures in the institutionalised elderly population.
Consensus recommendations included:
- Vitamin D supplementation is recommended for all institutionalised older persons. Residential aged care facilities (RACFs) should also encourage appropriate sun exposure for residents.
- Calcium supplements were not generally endorsed. However, a calcium rich diet should be encouraged for all residents of aged care facilities.
- A multi-factorial falls prevention program should be implemented. The program should include balance re-training and regular exercise at least twice a week.
- Measurement of bone mineral density (BMD) is difficult in residents of aged care facilities, and the results are of limited value for predicting fracture risk in this population. In the future, diagnosis of osteoporosis and the decision to treat should be based on an overall fracture risk assessment rather than a BMD value.
- Treatment for osteoporosis is encouraged for all residents at high fracture risk, unless considered inappropriate for an individual patient. Treatment choices include oral and intravenous bisphosphonates, as well strontium ranelate.
- Due to compliance and tolerance issues with oral medication, intravenous bisphosphonates may be a good alternative for institutionalised older people.
The meeting was organised by Associate Professor of Geriatric Medicine Gustavo Duque, who is Head of the Discipline of Geriatric Medicine and Director of the Aging Bone Research Program at the Nepean Clinical School, University of Sydney. The meeting was endorsed by Osteoporosis Australia, the Australia and New Zealand Bone & Mineral Society, the University of Sydney, the Aging Bone Research program and the RACGP, and was supported by an unrestricted educational grant from Novartis Pharmaceuticals.
Nepean Consensus Statement