Osteoporosis
Osteoporosis and rare bone disease service
IMPORTANT INFORMATION FOR OSTEOPOROSIS PATIENTS
Date of Advice April 2nd 2025
New Patients
It is likely that the reason for your GP referral to our
Osteoporosis service is to consider an injectable treatment (such
as zoledronic acid or denosumab) to protect your bones.
In the meantime, we would ask you to contact your GP for advice
on alternative treatments. This is particularly important if you
have already tried a tablet treatment such as alendronic acid
(alendronate), and this did not agree with you.
The Royal Osteoporosis Society provides a lot of information
which you may find helpful https://theros.org.uk/
Some alternative medications for you and your GP to
consider:
If intolerant to alendronic acid tablets (mainly digestive
symptoms), please consider:
- Soluble version of alendronate (Binosto) -men
and women
- Weekly Risedronate(35mg) -men and
women
- Monthly Ibandronate(150mg) -women
only
- Consider adding gastric protection (eg omeprazole or
ranitidine)
If there is a contraindication to, or intolerance of oral
bisphosphonates, please consider:
- HRT: in young postmenopausal women with
low thrombotic risk, particularly if menopausal symptoms present.
Avoid if history of any gynaecological malignancy (suspected or
confirmed).
NOGG 2024 guidance is an excellent resource and covers all of
the commonly asked questions regarding osteoporosis assessment and
management https://www.nogg.org.uk/full-guideline
Referrals for a bone mineral density test
(DXA)
Please refer via ICE. Ideally a repeat DXA should be carried out
on the same DXA machine as the patient's previous test. It is very
helpful to us if you can specify where their previous DXA was
carried out (it is important to note that we have two DXA machines
at Bristol Royal Infirmary - one in the Radiology department and
the other in the Rheumatology department. As a result there are two
ways to request a DXA via ICE; through Radiology and through
referrals - Rheumatology adult DXA referral).
If a patient needs to have a DXA in Weston-Super-Mare, please
request using the ICE request 'DXA scan (Adult Only)' and selcect
Weston as the location.
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1 in 2 women and 1 in 5 men over the age of 50 will break a
bone. 3 million people in the UK are estimated to have
osteoporosis. This condition can also rarely affect children.
The osteoporosis service at University Hospitals Bristol and
Weston provides a specialised service for osteoporosis and rarer
metabolic bone disorders and aims to help clinicians identify those
people most at risk of low impact fractures (broken bones) and then
manage them appropriately with a combination of education, physical
therapy and drugs.
Our multidisciplinary team is led by Dr Matt Roy, consultant
rheumatologist. The team is supported by an osteoporosis specialist
nurse (Mr Ronu Roy), a rheumatology registrar, DXA technicians,
therapies team and clinic co-ordinators.
We have access to a full set of laboratory services including
serum bone turnover markers. We have a Hologic Horizon A DXA
scanner which is able to perform a vertebral fracture assessment
(VFA). There is a Hologic Discovery A DXA scanner in our
Radiology department.
What we offer
Patients at relatively high risk of fragility fracture can be
referred for a DXA scan by their GP. This can be done via an ICE
referral. The reports are all written or checked by a consultant
and provide clinical advice for the referrer.
More complex patients, or those that have not tolerated oral
therapies, may be referred for an outpatient assessment. To refer a
patient to the osteoporosis clinic, please send a written referral
via the eRS system.
Regional advice is also available if there are any queries
regarding drug holidays and duration of treatment. This information
can be found on the Remedy BNSSG osteoporosis webpage
remedy pathway (bnssgccg.nhs.uk)
Parenteral therapies
Although initial drug treatment is usually oral medication,
sometimes this is unsuitable and alternatives are required. These
may include:
Zoledronic acid: Patients receive this
intravenous bisphosphonate therapy on our specialised day case
unit. This particular medication is usually given on a 12 - 18
month basis. To find out more about this treatment, click here:
Osteoporosis treatments: zoledronic acid (theros.org.uk)
Denosumab: This is given by six-monthly
subcutaneous injections for patients at high risk of fracture. The
first injection is given in our department, with further doses
administered in general practice.It is very important that
this treatment is given on time and NOT to stop denosumab without a
further treatment plan in place.
Otherwise, patients may be at greater risk of vertebral fracture
after stopping. Click here for shared care guidance:
Royal Osteoporosis Society | Denosumab (theros.org.uk)
Teriparatide: This anabolic drug is
administered as a daily subcutaneous injection over a two year
period. It is available for patients at high risk of fracture who
fulfil NICE criteria https://www.nice.org.uk/guidance/TA161/chapter/1-Guidance
Abaloparatide: This anabolic drug is
administered as adaily subcutaneous injection over an 18-month
period. It is available for patients at high risk of fracture who
fulfil NICE criteria Overview |
Abaloparatide for treating osteoporosis after menopause | Guidance
| NICE
Romosozumab:This is a new injectable treatment
available for post-menopausal women at high risk of fracture and
who have already had a recent fracture (within last 24 months).
This is given as a sub-cutaneous injection once monthly for 12
months.
Osteoporosis treatment: Romosozumab (theros.org.uk)
Patient Education
The team provides a patient education program for patients with
osteoporosis, or at increased risk of fracture, who want to learn
more about the condition. This is led by our osteoporosis nurse
specialist Ronu Roy, senior physiotherapist and occupational
therapist and is run over a 6-week period covering all aspects of
the condition including exercise. The aim of the sessions is to
provide people with the information and tools to help them manage
their condition effectively. Patients will also have the chance to
meet other people with the same condition and share their
experiences.
Bone Health for Older People (BHOP) Service and Fracture
Liaision Service (FLS)
The BHOP service is a partnership between the care of the
elderly team and the rheumatology unit. The aim is to
significantly reduce the risk of patients with fragile bones who
have had a low trauma fracture having another.
The Fracture Liaison Service (FLS) is led by Dr Abby Cannon,
consultant geriatrician, supported by specialist FLS nurses and
consultant colleagues, Dr Rachel Bradley and Dr Emma-Kate Reed.
This is a case-finding service to highlight individuals who may be
at high risk of fracture then get them started on treatment if this
is the case.
Together they also run a Bone Health for Older People
(BHOP) outpatient clinic focusing on frail older patients who have
osteoporosis and are at high risk of falling.
Childhood Osteoporosis
Dr Toby Candler is a paediatric endocrinologist with a special
interest in osteoporosis in childhood. He leads a regional service
for patients with complex or severe osteogenesis imperfecta (OI).
In addition, Dr Candler takes consultant to consultant referrals
for children with, or suspected to have osteoporosis. Dr Candler is
based at Bristol Royal Hospital for Children, Paul O'Gorman
Building, Upper Maudlin St, Bristol, BS2 8BJ.
The rheumatology unit carries out scans in children which are
reported by Dr Candler. Patients that have attended the regional OI
service transition to be followed up in the adult osteoporosis
clinic with Dr Matt Roy.
How to access our services
We accept local and regional referrals from both primary and
secondary care for adults considered to be at increased fracture
risk.
GPs, consultants or specialist healthcare professionals may
refer patients to the osteoporosis clinic (suitable for complex
cases, or for patients who are at high fracture risk and unable to
tolerate first line oral therapies - a scan will not normally be
carried out within 2 years of any prior measurement) via an eRS
referral.
GPs wishing to arrange a DXA scan for their patients can do so
through the ICE referral system. The scan will then be triaged to
be performed either in the Radiology or Rheumatology department DXA
scanner. This will be partly dependent on whether or not the
patient has had a previous scan with us before.
If a patient is >75 and they are not known to our
Rheumatology service, we would recommend referral to the Bone
Health for Older People (BHOP) Service at Bristol Royal
Infirmary.
Useful links
Remedy BNSSG osteoporosis guidance
remedy pathway (bnssgccg.nhs.uk)
NOGG 2024 guidance https://www.nogg.org.uk/
Fracture Risk Assessment Tool (FRAX) https://www.shef.ac.uk/FRAX/tool.jsp
The Royal Osteoporosis Society https://theros.org.uk/
Calcium calculator
https://www.osteoporosis.foundation/educational-hub/topic/calcium-calculator
NHS UK https://www.nhs.uk/conditions/osteoporosis/
Patient information on medication related osteonecrosis of the
jaw (MRONJ)
https://www.sdcep.org.uk/media/hefd1mjp/sdcep-mronj-information-for-osteoporosis-patients.pdf
