Checklist for Early Detection

This checklist is designed to assist busy primary care clinicians in the early detection of osteoporosis and fracture risk, supporting timely investigation, intervention, and referral where appropriate. It is consistent with Osteoporosis NZ’s broader commitment in Stronger Together: A Collaborative Strategy for Bone Health in New Zealand to promote a systematic, life-course approach to bone health – spanning primary fracture prevention, secondary fracture prevention, and high-quality care after fracture. It also aligns with the 5IQ-based Clinical Standards for Fracture Liaison Services (FLS), which emphasise identification, investigation, information, intervention, integration, and quality.

Early detection matters – use this checklist to identify people at increased risk of fracture, support early intervention, and enable coordinated prevention and care.

Identification

1. Fragility Fractures
   • Identify patients with a history of fragility fractures, especially hip, spine, wrist, pelvis or humerus fractures.
   • Identify patients with a parental history of fragility fracture, hip fracture in particular.
2. Medication Use
   • Assess patients using medications associated with bone loss, such as glucocorticoids (≥3 months), aromatase inhibitors, and androgen deprivation therapy.
3. Medical Conditions
   • Assess fracture risk in patients with chronic inflammatory diseases (e.g., rheumatoid arthritis, COPD), malabsorption conditions (e.g., coeliac disease), diabetes, or cognitive impairments (e.g., dementia).
4. Lifestyle Factors
   • Consider lifestyle risk factors such as smoking, excessive alcohol consumption, low body weight, and sedentary behaviour.

Investigation

1. Clinical Risk Assessment
   • Utilise fracture risk calculators (e.g., FRAX® or the Garvan Fracture Risk Calculator) to evaluate the 5-year or 10-year probability of fractures.
2. Bone Density Testing
   • Recommend DXA scans for at-risk patients to measure bone mineral density.

Information

1. Bone Health
   • Provide patients with information on osteoporosis, risk factors, and preventive measures:
     • Please suggest that patients visit the Individual and Families section of the Osteoporosis New Zealand website.
   • Discuss the importance of calcium and vitamin D intake, regular weight-bearing exercises, and lifestyle modifications.
2. Falls Prevention
   • Educate patients about falls prevention strategies, including home safety modifications and balance training exercises.
   • Consider referral to a Strength and Balance Class and/or Falls Prevention Service.

Intervention

1. Pharmacologic Treatment
   • Initiate osteoporosis-specific treatments for patients at high risk of fractures.
2. Non-Pharmacologic Measures
   • Recommend dietary adjustments, supplements where needed, and tailored exercise programmes to improve bone health and reduce fracture risk.

Integration

1. Referral Systems
   • Establish clear referral pathways to osteoporosis specialists, dietitians, physiotherapists, and falls prevention programs.
2. Follow-Up
   • Implement regular follow-up appointments to monitor bone health, adherence to treatment, and adjust interventions as necessary.

Quality

1. Performance Review
   • Regularly review and update clinical practices based on the latest evidence and guidelines.
   • Engage in continuous professional development related to osteoporosis management.