Useful information about working in Endocrinology

If a patient > 65 years is admitted with a clinical vertebral/hip/pelvic/humerus/radial fracture, it is reasonable to consider bisphosphonate treatment.
IV zoledronate is now fully funded and should be considered before discharge, renal function permitting (see below). Risedronate and Alendronate oral therapy do not require a Pharmac Special Authority application.
For other patients (those not admitted for treatment of a fracture), determine clinical risk factors, and fracture risk (see below).
A bone mineral density assessment (DEXA scan) is not required if this will delay treatment.
If zoledronate infusion is given, document this in the discharge summary and ask GP to follow-up for potential repeat infusion in 2-3 years.
Consider referral to Bone Clinic (for more complex cases).

Low impact fracture of the vertebrae, hip, pelvis, proximal femur, humerus or forearm
Any fracture at a major skeletal site in an older adult should be assessed (except digits, face and skull)
Age ≥65 years (women) and ≥75 (men)
Smoking (current)
Current/recent use of glucocorticoids
Early menopause
History of falls
BMI ≤20 kg/m2

Use https://www.sheffield.ac.uk/FRAX/tool.aspx?country=1 (ensure Oceania: New Zealand is selected under calculation tool tab).
Another fracture risk calculator is Garvan Fracture Risk Calculator (garvan.org.au).
If 10-year FRAX/Garvan hip fracture risk is ≥3% or major osteoporotic fracture risk is ≥20%, consider initiating bisphosphonate therapy.
If eGFR or CrCL >35 mL/min, IV zoledronate is an option.
Discuss fracture risk and side effects of zoledronate (Aclasta) infusion with patient.
- Common side effects (≥1 in 100) include mild transient flu-like symptoms, fever, headache, dizziness within 72 hours following the infusion.
- Less common side effects include eye inflammation (about 6/1000) and osteonecrosis of the jaw (ONJ).
If CrCL <35 mL/min discuss with Endocrinology Registrar regarding oral bisphosphonates and potential referral to Bone Clinic.