Home' Australian Pharmacist : August 2011 Contents Vol.30–August#08
The articles in this series are independently researched and compiled by PSA commissioned authors and peer reviewed.
• Cancer Council Australia provides
information on obtaining sufficient
vitamin D whilst minimising the
risks of UV exposure. At:
Cindy explains that she was
diagnosed with Crohn’s disease
five years ago after experiencing
years of stomach problems. She
has been taking long courses of
‘steroids’ for severe symptoms over
the last few years but she recently
stopped these as her Crohn’s seems
to have stabilised. Cindy’s doctor
has recommended that she stop
smoking, improve her diet and talk to
her physiotherapist about exercising.
You can reassure Cindy and provide
advice on ways to improve her
health and minimise risk of fractures.
Smoking cessation and good
nutrition can improve both fracture
risk and Crohn’s disease. Explore
her diet and lifestyle, particularly in
relation to calcium and Vitamin D.
Regular exercise will help recovery
and maintain good bone health.
The physiotherapist may consider
starting her on an exercise program
like hydrotherapy as she recently
suffered a spinal fracture, and then
progressively increase exercise
difficulty. It is important to emphasise
the need for good posture as any
movement requiring her to bend
forward, particularly whilst carrying
something, can cause compression of
the spine and possible fracture.
Take home message
Osteoporosis is uncommon in
premenopausal women. Secondary
causes and risk factors for
osteoporosis should be explored
and addressed where possible.
Pharmacists are ideally placed to
provide ongoing reassurance and
support to these young women.
Timely lifestyle advice and provision
of consumer resources may aid
recovery after fracture, improve bone
health and minimise risk factors for
1. National Prescribing Service. Alendronate (Fosamax)
for osteoporosis – preventing fractures in people with
very fragile bones (low bone mineral density). Medicine
update. Sydney: National Prescribing Service; 2008. pp
2. Cohen A. Should bisphosphonates be used in
premenopausal women? Maturitas. 2010; 66 (1):3–4 .
3. Endocrinology Expert Group. Therapeutic guidelines:
endocrinology. Version 4. Melbourne: Therapeutic
4. Bhalla AK. Management of osteoporosis in a pre-
menopausal woman. Best Pract Res Clin Rheumatol.
5. Romas E. Corticosteroid-induced osteoporosis and
fractures. Aust Prescriber. 2008; 31:45–9.
6. Rheumatology Expert Group MTGL. Therapeutic
guidelines: rheumatology. Version 2. Melbourne:
Therapeutic Guidelines; 2010.
7. National Prescribing Service. Maintaining bone health
to prevent osteoporotic fractures. NPS News 53.
Sydney: National Prescribing Service; 2007. pp 1–6.
8. The Royal Australian College of General Practitioners.
Detection, prevention and treatment of osteoporosis.
Treatment algorithm. Australia: RACGP; 2011. pp 1–2 .
9. Rossi S, ed. Osteoporosis. Adelaide: AMH; 2011.
10. National Prescribing Service. Reducing fracture risk
in osteoporosis. NPS News 73. Sydney: National
Prescribing Service; 2011. pp 1–4.
11. Rossi S, ed. Bisphosphonates. Adelaide: AMH; 2011.
12. Adverse Drug Reactions Unit. Osteonecrosis of the
jaw with bisphosphonates. Adverse Drug Reactions
Bulletin. 2006; 25(4).
13. Therapeutic Goods Administration. Bisphosphonate
drugs and osteonecrosis of the jaw (ONJ). Canberra:
Department of Health and Ageing; 2007.
14. Merck Sharp & Dohme. Fosamax – alendronate sodium.
CMI. Sydney; 2009; 5.
15. Vondracek SF, Hansen LB, McDermott MT. Osteoporosis
risk in premenopausal women. Pharmacotherapy. 2009;
16. National Prescribing Service. Testing and treating
vitamin D deficiency. NPS News 72. Sydney: National
Prescribing Service; 2011. pp 1–6.
17. Joshi D, Center JR, Eisman JA. Vitamin D deficiency in
adults. Australian Prescriber. 2010; 33(4):103–6.
18. Singh MAF. Exercise and fracture prevention: A guide
for GPs & health professionals. Osteoporosis Australia;
2007; 5–8 .
19. World Health Organisation Collaborating Centre
for Metabolic Bone Diseases. WHO fracture risk
assessment tool [online, accessed 25 May 2011].
At: www.shef.ac .uk/FRAX
20. Garvan Institute. Fracture risk calculator [online,
accessed 25 May 2011]. At: www.garvan.org.au/bone-
1. Which of the following medical
profiles for a premenopausal
woman is MOST LIKELY
to indicate a diagnosis of
a) A Z-score of -2.2 in a woman
taking prednisone 5 mg daily for
b) A T-score of -2 .5 in a smoker with
a family history of osteoporotic
c) A Z-score of -2 .2 in a smoker with
a family history of osteoporotic
d) A Z-score of -2 .2 in a smoker with
a personal history of osteoporotic
2. Which of the following
osteonecrosis of the jaw (ONJ)
a) ONJ involves inflammation of the
jaw bone (mandible or maxilla).
b) ONJ is most likely to occur in the
first few months after starting
c) The risk of ONJ is increased in
people on long-term therapy.
d) Any tooth extractions required
should be completed as quickly as
possible after starting therapy.
3. Which of the following can
be done within 30 minutes of
a) Drinking a cup of tea.
b) Going for a brisk walk.
c) Drinking a glass of mineral water.
d) Going back to bed.
4. Which of the following
activities is likely to have the
MOST BENEFICIAL impact
on bone health and risk of
A score of 4 out of 5 attracts 1 CPD credit.
a) Tai Chi weekly and weight training
and brisk walking three times each
b) Swimming three times a week.
c) Walking casually to the shops four
times a week.
d) Heel to toe walking and Tai Chi
twice per week.
5. A 34-year-old woman with
osteoporosis asks your
advice on obtaining enough
calcium each day. Which of the
following options would be
a) One calcium carbonate 1.5 g tablet
and a glass of milk.
b) Four tablets of calcium citrate 1.19
g per tablet.
c) One calcium carbonate 1.5 g tablet,
two slices of cheese and one tub
d) A glass of milk, two slices of
cheese and a tub of yoghurt.
counselling in practice
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