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Osteoporosis: disease characterised by low bone mass and structural…

- - - - Those under the age of 50 with current or frequent use of oral corticosteroids , untreated premature menopause or a previous fragility fracture.
        
        Those under the age of 40 with current or recent use of high dose oral corticosteroids as per NICE Guidance. Previous fragility fracture of spine, forearm, hip or proximal humerus or history of multiple fragility fractures.
        
        Consider assessing fracture risk in those taking selective serotnin reuptake inhibitors, PPIs, antiepileptic medications, Aromatase inhibitors or Thiazolidinediones.
  - - - Assess need for further investigation for possible underlying cause if no osteoporotic causes - eg metastatic bone disease, multiple myeloma, osteomalacia or Pagets disease.
        
        Exclude secondary causes in those with a fragility fracture and low risk. Possible causes include endocrine conditions, rheumatological conditions, chronic liver disease, GI disorders or COPD.
- - - - Factors that do not reduce BMD: Age, smkoing, alcohol intake, rheumatological conditions, family history of hip fractures and oral corticosteroid use (dependant on dose and duration).