Oral Presentation Sydney Spinal Symposium 2019

OP and Back Pain - drugs that a GP should know and Drugs a Surgeon Should Learn about (#16)

Christopher White 1 2
  1. SESLHD, Sydney
  2. Prince of Wales Hospital Randwick, Sydney

The diagnosis and treatment of osteoporosis has rapidly advanced in keeping with other fields of medicine and surgery. Primarily involving postmenopausal women and elderly men the condition is not limited to these ages groups and can be considered in all cases where spinal fractures occur spontaneously of following minimal trauma. Treatment can reduce rates of spinal fracture by 50% and multiple fractures by 90% and are now universally available and reimbursed for the treatment of the condition under most circumstances. Yet no more than 20% of patients leave hospital following a fracture on effective treatment. This is a missed opportunity comprising a failure to identify, investigate, initiate or monitor compliance with treatment. Research is required to understand and overcome these barriers so that the bulk of patients can and should be managed in primary care. The treatment options available are broadly classified antiresorptive or anabolic. Antiresoprtive options amenable to initiation and follow up in primary care include oral and intravenous bisphosphonates or subcutaneous administration of denusomab. Potent anabolic options can be considered in the treatment paradigm. For now these reside in the domain of specialist practice but are time limited following initiation. Recent evidence suggests that the sequence of their initiation requires careful consideration and an ongoing need for antiresorptive therapy thereafter or the gains are lost. Risks of adverse consequences from exposure to either drug class have been over emphasised and remain rare and isolated events that occur at orders of magnitude below the risk of recurrent fracture. Osteoporosis is now a treatable and at times curable disease. Overcoming  “fractured” service delivery models is now as big a problem as the diagnosis and treatment of the disease.