ia_gov_sa · guide · processed · 6 chunks
Council of Cooperative Health Insurance Osteoporosis Clinical Practice Guidelines الجمعه السعوديه لطب الاشرك والمجتمع Saudi Society of Family and Community Medicine Initial Evaluation for Osteoporosis All postmenopausal women age ≥50 years of age should undergo clinical assessment for osteoporosis and a detailed history, physical exam, and clinical fracture risk assessment with Fracture Risk Assessment tool (FRAX®) Note: FRAX age 40-90, Saudi FRAX in process of endorsement. Use USA white as per Saudi Osteoporosis Society SOS1). Or the Kuwaiti FRAX (similar hip fracture incidence to Saudi Arabia) until the Saudi FRAX is available <table><tr><td>History</td><td>Exam</td><td>FRAX Clinical risk factors in FRAX®www.shef.ac.uk/FRAX</td></tr><tr><td>Prior osteoporosis-related fracturesProlonged steroid useHeight loss >6 cm historicallyCurrent smokingExcess alcohol≥ 3 units per dayParental hip fractureFalls in past 12 monthsOther high-risk conditions or medications</td><td>Height loss (>2cm prospectively)Weight (BMI)Low <60 KgMajor loss (≥10% of weight since age 25)KyphosisRib to pelvis distance >2 FBsBalance and gait, “Get up and Go” Test</td><td>ageSexbody mass index (BMI)smoking, alcohol useprior fractureparental history of hip fractureuse of glucocorticoidsrheumatoid arthritissecondary osteoporosisfemoral neck BMD</td></tr><tr><td colspan="3">Indications for BMD Testing (1)</td></tr><tr><td colspan="3">Menopausal women, and men aged 50-64 yearsRoutine Screening indicated by age</td></tr><tr><td colspan="3">Menopausal women, and men aged 50-64 years with clinical risk factors for fracture:All women ≥40 years who have sustained low-trauma fragility fracturePrevious fragility fracture or maternal history of hip fracture.hypogonadism or premature menopause (< 45 years), Prolonged secondary amenorrhea (>1 year)Prolonged glucocorticoid use≥ 3 months cumulative use in the past year of prednisone-equivalent dose ≥ 7.5mg dailyOther high-risk medication use (tamoxifen, thiazolidinedione, Empagliflozin, PPI and anticonvulsant)X-ray findings suggestive of osteoporosis such as vertebral fracture, osteopenia identified on X-ray, fragility fracture, loss of height, or thoracic kyphosis (clinical or radiological finding)Current smokingHigh alcohol intakeLow body weight (< 60 kg) or major weight loss (>10% of weight at age 25 years)Rheumatoid arthritisOther disorders strongly associated with osteoporosis such as primary hyperparathyroidism, type 1 diabetes, osteogenesis imperfecta, uncontrolled hyperthyroidism, Cushing's, disease, chronic malnutrition or malabsorption, chronic inflammatory conditions (e.g., inflammatory bowel disease)</td><td>All women age ≥ 60 years in Saudi Arabia (expert opinion screen)All men age ≥ 65 years</td></tr></table> Council of Cooperative Health Insurance الجمهوريه المطرفيه السعوديه العامه للشركه والمحترم Saudi Society of Family and Community Medicine 2020 AACE American Association of Clinical Endocrinologists Diagnosis of Osteoporosis in Postmenopausal Women (2) 1. T-score -2.5 or below in the lumbar spine, femoral neck, total proximal femur, or 1/3 radius 2. Low-trauma spine or hip fracture (regardless of bone mineral density) 3. T-score between -1.0 and -2.5 and a fragility fracture of proximal humerus, pelvis, or distal forearm 4. T-score between -1.0 and -2.5 and high FRAX® (or if available, TBS-adjusted FRAX®) 10-year probability for major osteoporotic fracture is ≥20% or the 10-year probability of hip fracture is ≥3% FRAX® = fracture risk assessment tool; TBS = trabecular bone score For All Osteoporotic Patient Evaluate for Causes of Secondary Osteoporosis Before Start Treatment - Serum chemistry: TSH calcium, phosphate, total protein, albumin, liver enzymes, alkaline phosphatases, creatinine, and electrolytes. - Serum 25-hydroxyvitamin D Complete blood cell count - SPE serum protein electrophoresis if vertebral fracture or suspect multiple myeloma - X-ray lateral thoracolumbar screen for vertebral fracture if not available from DXA Recommend pharmacologic therapy Education on lifestyle measures, fall prevention, benefits, & risks of medications Treatment for Osteoporosis According to Fracture Risk CALCIUM Instructions: Calcium should be taken before absorption. calcium should not be adversely CALCIUM Instructions: Calcium should be taken before absorption. calcium should not be adversely affected when CALCIUM Instructions: Calcium should be taken with history of renal st tions should not be e taken with iron (absorptio e adversely CALCIUM The Ground Truth image displays a single, solid horizontal line. According to Rule 2 (UNDERSCORE & LINE RULES), this is a stylistic or background line, not a placeholder underscore. Therefore, the OCR result must ignore it and output nothing or only meaningful text. The provided OCR content is "____", which consists of four underscores. This is an incorrect interpretation of the line as a placeholder, violating the rule that stylistic lines must be ignored. The OCR has hallucinated underscores where none should exist based on the GT's visual context. Hence, the OCR result is inconsistent with the Ground Truth. Instructions: Calcium should be taken with after 3 hours before the absorption. Calcium should not be taken before adversely \( \therefore m - 1 \neq 0 \) ; Council of Cooperative Health Insurance University of California School Security of Family and Community Medicine Recommend: Education on lifestyle measures, fall prevention, benefits and risks of medications <table><tr><td>Exercise type /benefits</td><td>Frequency</td><td>Comment</td></tr><tr><td>Posture exercises keep you standing tall, not stooped.</td><td>Daily 10 mint</td><td>Pay attention to your posture posture when you stand and sit, do back exercises that extend your spine.</td></tr><tr><td>Balance exercises help you be more stable on your feet. You can walk more easily. Good balance helps prevent falls.</td><td>Daily 20 mint</td><td>walk heel to toe, reduce base of support, shift your weight, respond to things that upset your balance.</td></tr><tr><td>Strength exercises keep you strong and fit.</td><td>2 times per week</td><td>Exercise for leg ,arm ,chest shoulder and back. Use body weight against gravity ,band and weights *</td></tr><tr><td>Aerobic physical activity (moderate to vigorous intensity) improves your overall health. It can reduce your risk of disease. It may improve your bone strength.</td><td>150 minutes per week</td><td>Do aerobic physical activity for about 20 to 30 minutes per day. Exercise for at least 10 minutes at a time. In total, do 150 minutes or more per week.* If you are new to exercise or if you have had a spine fracture, start at low to moderate intensity — 3 to 6 on the scale*</td></tr></table> *Refer to physical therapy for advice for proper exercise for each patient Give patient medication card when starting the treatment this is essential for collaborative medical care between specialist and primary care example: Abaloparatide or Teriparatide taken once in life time for up to 2 years and need to be followed by antiresorptive treatment. Moreover, it is essential to know when the patient can go for drug holiday. Medication: ____ Calcium: Dietary sources: ____ mg Supplements: ____ mg Vitamin D: Exercise: ____ minutes daily / weekly Fall Prevention advice ____ Follow up DXA / labs in ____ months. Return visit in ____ months References: 1. 2015 Guidelines for Osteoporosis in Saudi Arabia: Recommendations from the Saudi Osteoporosis Society Ann Saudi Med 2015;35(1):1-12 2. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS/ AMERICAN COLLEGE OF ENDOCRINOLOGY CLINICAL PRACTICE GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS— 2020 UPDATE Endocr Pract. 2020;26(Suppl 1) 3. Camacho et al. Endocr Pract. 2020.26.564-570 4. Shoback et al. J Clin Endocrinol Metab, 2020, 105(3), 1-8 5. Eastell et al. J Clin Endocrinol Metab. 2019, 104, 1595-1622 6. Kanis et al. Osteoporosis Int. 2020, 31, 1-12