Frequently Asked Questions

Readily identifiable high-risk groups include individuals with a personal history of fragility fractures, and those with a parental history of fragility fractures, particularly hip fractures. Patients using medications associated with bone loss, such as glucocorticoids (for ≥3 months), aromatase inhibitors, or androgen deprivation therapy, also have increased risk. Additionally, chronic inflammatory diseases (e.g., rheumatoid arthritis, COPD), malabsorption conditions (e.g., coeliac disease), diabetes, and cognitive impairments (e.g., dementia) elevate fracture risk. Lifestyle factors, including smoking, excessive alcohol consumption, low body weight, and sedentary behaviour, further contribute to osteoporosis risk.

A fragility fracture is a break that occurs from a fall at standing height or less, indicating underlying poor bone health. Common sites for fragility fractures include the hip, spine, humerus, pelvis, and wrist, although any low-trauma fracture - excluding those of the toes, fingers, and skull - is considered a fragility fracture. Research shows that experiencing a fragility fracture doubles the risk of future fractures, with up to half of individuals who sustain hip fractures having had a prior fracture.

Primary care doctors can use our Checklist for Early Detection to efficiently identify high-risk groups, conduct necessary investigations, and provide evidence-based interventions.

Medications commonly associated with bone loss, or an increased risk of fractures include glucocorticoids, aromatase inhibitors, and androgen deprivation therapy.

Conditions such as rheumatoid arthritis, chronic obstructive pulmonary disease (COPD), coeliac disease, diabetes, and cognitive impairment are associated with an increased risk of developing osteoporosis and/or sustaining fragility fractures

Low body weight is linked to reduced bone density, increasing the likelihood of fractures. Lower body weight is also often associated with reduced muscle mass, providing less support to the bones and increasing falls risk.

A family history of osteoporosis or hip fractures notably raises a patient’s fracture risk. Primary care doctors are encouraged to promote cascade screening by recommending the Know Your Bones™ tool to family members of patients with fragility fractures, helping identify and manage risk early in relatives who may also be at risk.

Yes, frequent falls significantly increase the likelihood of fragility fractures, particularly in individuals with low bone density. In New Zealand, falls are the leading cause of injury among older adults, with one in three people over 65 years experiencing a fall each year. This risk increases with age, rising to one in two for those over 80 years.

Menopause, particularly before 45 years of age, accelerates bone loss due to decreased oestrogen, increasing fracture risk.

Adapted for use in New Zealand by bpac^nz in collaboration with the Health Quality and Safety Commission, this resource provides practical, evidence-based approaches to falls prevention tailored to the New Zealand healthcare context. View this tool here.

The FRAX® and Garvan Fracture Risk Calculator assess a patient's 5- to 10-year fracture probability based on multiple factors.

Dual-energy X-ray absorptiometry (DXA) scanning plays an important role in diagnosing osteoporosis by measuring bone mineral density (BMD), a key predictor of fracture risk. Ideally, BMD should be assessed at two sites: the anteroposterior lumbar spine and the hip. In older adults, however, degenerative changes in the spine may lead to artificially elevated BMD readings, making hip DXA generally more reliable for accurate assessment

For high-risk patients, follow-up DXA scans every 4-5 years are recommended to track bone density changes.

The T-score indicates where a patient falls on the full spectrum of bone mineral density (BMD), helping to assess fracture risk. A T-score between -1.0 and -2.5 reflects osteopenia, an early stage of bone loss requiring timely intervention to prevent progression to osteoporosis. A T-score ≤ -2.5 signifies osteoporosis, where treatment to reduce fracture risk is generally necessary. Importantly, individuals with fragility fractures - whether osteopenic or osteoporotic - are a high-risk group. These patients need a comprehensive fracture risk assessment, and in most cases, pharmacological intervention is indicated to prevent future fractures.

Z-scores, which compare bone density to age-matched peers, are useful in assessing bone loss in younger patients.

Yes, fracture risk calculators can estimate risk without DXA results, although DXA is preferred for precise diagnosis. The FRAX® and Garvan Fracture Risk Calculator assess a patient's 5- to 10-year fracture probability based on multiple factors.

High-resolution peripheral QCT (HR-pQCT) and Quantitative CT (QCT) provide detailed assessments of bone geometry and microarchitecture. These scans are only performed in research setting and are not readily available in New Zealand.

Bone quality includes factors like geometry, microstructure, and mineralisation, which affect bone strength beyond density alone.

Lateral X-rays of the thoracolumbar spine can identify vertebral fractures, which are often indicative of underlying osteoporosis.

The UK Royal Osteoporosis Society’s Vertebral Fracture Initiative encourages radiologists to routinely check for vertebral fractures on all relevant scans, which significantly aids in identifying osteoporosis early. By adopting a similar approach in New Zealand, hospital radiology departments and private radiology providers could play a crucial role in early osteoporosis detection, ensuring that vertebral fractures are promptly reported and integrated into patient care.

Explain bone density results in simple terms, emphasise risk factors, and offer a clear management plan for bone health.

Topics include the importance of bone density scans, lifestyle changes, medications, and follow-up for effective care.

Family support is crucial in care management, falls prevention, and ensuring the patient adheres to treatment plans.

Cascade screening involves assessing family members’ risk, particularly in those with a family history of fractures. Primary care doctors are encouraged to promote cascade screening by recommending the Know Your Bones™ tool to family members of patients with fragility fractures, helping identify and manage risk early in relatives who may also be at risk.

This online tool helps assess personal fracture risk and provides a conversation starter for discussing bone health.

Programmes like My Hip My Voice and the Caring After a Fracture (CARE) educational series guide caregivers on supporting patients through recovery.

Acknowledge conditions such as arthritis, diabetes, and malabsorption that impact bone health, ensuring patients understand their risks.

Regular exercise, quitting smoking, limiting alcohol, and ensuring adequate calcium (through dietary intake) and vitamin D (mainly through sunlight exposure and/or supplementation) are important preventive measures.

Encourage a diet with calcium-rich foods, vitamin D, and protein to support bone strength.

Address pain management, falls prevention, rehabilitation, and treatment of osteoporosis and monitoring.

Common treatments include bisphosphonates (alendronate, risedronate, zoledronate), denosumab, teriparatide, raloxifene, and HRT.

Bisphosphonates inhibit bone resorption, helping to maintain bone density and reduce fracture risk.

Zoledronate is an IV infusion typically given every 12 - 24 months, depending on the patient’s needs.

Denosumab, administered biannually as a subcutaneous injection, is suitable for those intolerant to bisphosphonates and patients with renal dysfunction (CrCl <35). It can also be considered where other treatment (generally a bisphosphonate) has not worked effectively in either preventing fractures or improving bone mineral density.

HRT supports bone density, especially in postmenopausal women, by replenishing oestrogen levels that decline with menopause.

While these treatments do not provide direct pain relief, they reduce fracture risk, thereby helping to prevent painful and traumatic events.

After 3-5 years of bisphosphonate therapy, a temporary intermission of treatment reduces risks of possible side-effects associated with continuous bisphosphonate therapy, such as osteonecrosis of the jaw and atypical femur fractures.

Dietary sources, particularly for calcium, are preferable; supplements are recommended only for those with very low dietary calcium intake. Vitamin D supplementation should be considered in those at risk of vitamin D deficiency (those with low skin exposure to sunlight e.g. institutionalised elderly, house-bound frail individuals, veiled women for religious/cultural reasons).

Common side effects include stomach upset with oral bisphosphonates, and flu-like symptoms with IV zoledronate. Rare but serious side effects, such as osteonecrosis of the jaw and atypical femur fractures, may occur with long-term use of certain osteoporosis medications.

Teriparatide, a daily injection, is reserved for severe cases of osteoporosis, especially in those with multiple fractures.

Weight-bearing, resistance, and balance exercises improve bone density, muscle strength, and reduce falls risk.

Walking, low-impact aerobics, strength training, and flexibility exercises like Tai Chi help maintain bone health safely.

Evaluate fall risk regularly, promote safe home modifications, and consider balance training resources like the Nymbl App. Adapted for use in New Zealand by bpac^nz in collaboration with the Health Quality and Safety Commission, the Stay Independent Falls Prevention Toolkit provides practical, evidence-based approaches to falls prevention tailored to the New Zealand healthcare context.

Combining medications, physiotherapy, and cognitive-behavioural strategies can address both acute and chronic pain.

Physiotherapy improves strength, balance, and posture, essential for preventing falls and fractures.

Early mobilisation and targeted therapy improve recovery, independence, and overall quality of life post-fracture.

Pain, depression, and fear of falling are common barriers, underscoring the need for psychological support.

Caregivers can help with daily tasks, encourage mobility, and support the patient in adhering to rehabilitation exercises.

Long-term pain management, particularly after vertebral fractures, may involve medications, physiotherapy, and psychological support for chronic pain.

Opioids may be necessary for severe pain but should be used cautiously due to side effects and potential dependence. Non-opioid analgesics, such as paracetamol and NSAIDs, are preferred.

An Orthogeriatric Service is a specialised care model that applies geriatric medicine principles to managing older adults with fragility fractures, especially hip fractures. This service focuses on the complex medical needs of elderly patients, who frequently have multiple comorbidities, increased frailty, and a heightened risk of future falls and fractures.

The Hip Fracture Care Clinical Care Standard outlines best-practice guidelines for the treatment and management of hip fractures in older adults. It serves as a benchmark for quality care, helping Orthogeriatric Services ensure that patients receive timely, coordinated, and effective treatment. Adhering to this standard can reduce complications, shorten hospital stays, and improve recovery outcomes

The ANZHFR enables hospitals to benchmark their hip fracture care against the Hip Fracture Care Clinical Care Standard, promoting adherence to best practices. By tracking outcomes and highlighting areas for improvement, the registry helps healthcare providers optimise patient outcomes, reduce complications, and ensure consistent, high-quality care across facilities. Annual reports from the registry also provide valuable insights into trends and performance, supporting ongoing quality improvement.

Fracture Liaison Services (FLS) are specialised teams focused on providing comprehensive care to patients aged 50 years or older with fragility fractures, aiming to prevent future fractures. FLS conducts thorough risk assessments, follows national osteoporosis treatment guidelines, and addresses fall risks through appropriate referrals. Their comprehensive evaluations streamline care, reducing the need for repeated investigations.

The second edition of the Clinical Standards for Fracture Liaison Services (FLS) in New Zealand provide best-practice guidelines for secondary fracture prevention. These standards set benchmarks for identifying, assessing, and managing patients with fragility fractures to ensure they receive comprehensive care aimed at preventing future fractures. The standards guide FLS programs in delivering effective, consistent care across New Zealand.

The ANZFFR enables Fracture Liaison Services (FLS) to benchmark the care they provide against the second edition of the Clinical Standards for FLS in New Zealand, fostering adherence to best practices in fracture prevention. By capturing data on patient outcomes and service performance, the registry identifies areas for improvement and promotes high-quality, standardised care. The registry’s annual reports also offer valuable insights, supporting FLS programs in optimising their services and reducing secondary fracture risks.

The Capture the Fracture® Programme, established by the International Osteoporosis Foundation (IOF) in 2012, is a global initiative aimed at reducing secondary fractures through the implementation of Fracture Liaison Services (FLS). The initiative provides a Best Practice Framework, offering internationally endorsed standards and guidance for effective secondary fracture prevention. Additionally, Capture the Fracture® offers resources, mentorship, and recognition to healthcare systems worldwide, supporting the establishment and enhancement of FLS.

HealthPathways is a key resource for primary care teams throughout New Zealand, offering standardised guidelines for assessing and managing various conditions, including osteoporosis. Available across 10 regional Community HealthPathways (CHP) sites, these pathways promote consistent care and define criteria for accessing publicly funded health services.

Throughout New Zealand, established private radiology networks provide widespread access to imaging services. These networks offer a valuable opportunity to enhance osteoporosis care by more actively integrating radiology, particularly for detecting vertebral fractures, which are frequently underdiagnosed.

Courses, webinars, and clinical publications from Osteoporosis New Zealand and international organisations such as the Fragility Fracture Network and the International Osteoporosis Foundation provide up-to-date training on osteoporosis management.