London Medical have introduced a rapid access one-stop approach to osteoporosis diagnosis and management. All following steps are carried out during a single visit to the London Medical clinic lasting less than two and a half hours:
1. Refer for consideration of bone density scanning depending on the presence of acknowledged risk factors.
2. Osteoporosis risk assessed through a detailed 38-point questionnaire.
3. Bone density scan performed on the on-site densitometer which includes instant vertebral assessment to meet the challenge of identifying vertebral fractures, the majority of which do not come to medical attention. This step also obviates the possible need for routine x-rays of the spine, and the dose of radiation is extremely low.
4. Consultation with an osteoporosis specialist.
5. Full investigations to exclude all the underlying, unidentified secondary causes for osteoporosis where appropriate; includes baseline measurements of biochemical markers of bone turnover.
6. Full discussion of treatment, according to the results of the bone density scans and those details obtained from the risk-assessment questionnaire, including lifestyle guidance and, where appropriate, medication.
Treatments
A wide range of treatments is available but increasingly there is a role for annual intravenous zoledronic acid as Aclasta 5mgs. The anti-fracture data are excellent and include protection against vertebral, hip and other non-vertebral fractures. In addition, a recent presentation at the American Society for Bone and Mineral Research unveiled an unexpected reduction in mortality of at least 28% over a two to three year period, when intravenous zoledronate is used following hip fracture, to prevent, successfully, fracture in the contralateral hip. Treatment once a year in the form of a 20 minute infusion is proving popular, convenient and obviously overcomes concerns about perseverance with treatment.
Those who attend London Medical and opt for intravenous zoledronic acid will be given full clinical osteoporosis and fracture risk-assessment, bone density scanning including vertebral morphometry, investigations and treatment at a single visit. This is a very exciting initiative and appears increasingly to be favored by patients. Subsequently, repeat biochemical bone markers are checked after three months, as these provide an indication of early response to treatment, and a further bone density scan usually carried out about 18 months later depending on an individual’s presentation.
On the horizon there are further promising developments with regards to the treatment of osteoporosis. Imminent, for example, is therapy which modulates osteoclast activity through the RANK-Ligand/ Osteoprotegerin pathway (Denosumab; Amgen). Such therapy targets selectively a component of bone metabolism and in many ways mirrors the effect of biologic agents employed in rheumatoid arthritis and other inflammatory arthropathies.
