In this episode of The Good GP, Dr Krystyna de Lange is once again joined by Dr Karen McGraith, for the second part of a two-part series focusing on the pharmacological management of osteoporosis. Dr McGraith is a member of the Medical and Scientific Advisory Committee with Healthy Bones Australia and the immediate past president of the Australasian Menopause Society.

They begin with a review of the clinical criteria for initiating pharmacological treatment in osteoporosis, highlighting the latest RACGP and Healthy Bones Australia guidelines. Outlining which patient groups should be considered for treatment, including those with minimal trauma fractures, based on T scores, and those assessed using FRAX risk calculations.

Providing insights into choosing between these treatments, taking into account the patient's age, fracture risk profile, comorbidities, potential adherence, cost, and PBS eligibility. Discussing risk-benefit considerations for each class of medication, as well as patient education, monitoring for side effects, and specific prescribing considerations such as dental health and renal function.

Dr McGraith addresses the importance of ongoing monitoring, including when to repeat bone mineral density testing, the rationale behind “drug holidays” for bisphosphonates, and the need for continuous therapy with denosumab. Highlighting key guidance points around therapy duration, transitioning between agents, and when to involve specialist care.

Links & Resources:

• Healthy Bones Australia fact sheets - https://healthybonesaustralia.org.au/your-bone-health/
• Australasian Menopause Society Practitioners Toolkit for the Management of Menopause - https://www.menopause.org.au/hp/information-sheets/practitioners-toolkit-for-management-of-the-menopause
• RACGP and Healthy Bones Australia Clinical Guidelines - https://healthybonesaustralia.org.au/health-care-professionals/guidelines-statements/

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