1. Osteoporosis & Bone Health: Development Manager, N. Ireland
An Overview
Hazel Buller
Development Manager, N. Ireland

2. Topic areas What is osteoporosis?
Bone health / lifestyle changes / ‘Prevention’
Diagnosis / ‘fracture risk assessment’
Drug treatments
Living with fragility fractures / broken bones
New support initiatives from the Charity

3. Healthy bone Osteoporotic bone
This slide shows what bone looks like when viewed under a microscope; with healthy bone on the left and osteoporotic bone on the right.
When bones become osteoporotic and fragile, the cortical bone (the outer shell) thins and the struts within the trabecular bone (inner mesh) also narrow and become less strong.
Eventually the architecture within the trabecular structure breaks down, leading to loss of bone strength and an increased risk fracture.
© Tim Arnett, University College London 3

4. The Living Skeleton Bone resorption Bone formation by osteoclast cells
by osteoblast cells
Resting phase
The Living Skeleton
Bone is a living tissue that is constantly changing or ‘remodelling’ throughout life
Old worn out bone is broken down by specialist cells called ‘osteoclasts’ and replaced by bone building cells called ‘osteoblasts’ in a process of renewal called ‘bone turnover’
During childhood it takes the skeleton just two years to completely renew itself. In adults this process takes seven to ten years
Slide top left shows osteoclasts wearing away the surface of bone and creating a cavity
Slide top right shows osteoblasts creating new bone
Slide bottom right shows new bone filling up the cavity
Slide bottom left shows bone resting before the process starts again
The Living Skeleton

9. N.B. more information will be provided in Rachel Hawthorne’s presentation and the leaflet ‘healthy living for strong bones’ is included in the delegate pack

10. Once again more information will be provided in Rachel Hawthorne’s presentation

11. N.B. more information will be provided in Sabrina Lynn’s presentation

12. Once again more information will be provided in Sabrina’s presentation

15. Bone health / lifestyle changes to prevent fractures
How much calcium do I need?
Do I need a supplement?
What about vitamin D?
What exercise can I do?
What can I do to stop falls?
Charity publications:
Exercise & osteoporosis;
Healthy Living for strong bones
Vibration therapy & osteoporosis
Further food facts
Start Active, Stay Active:
NHS Choices:

19. Falls Risk Assessment Tool (FRAT)
2013
A simple tool like this can help establish whether a person needs further assessment and/or referral for investigation/intervention

20. Drug treatments
Bisphosphonate adverse effects – ONJ and atypical fractures
Duration of treatment - ‘drug holidays’
Calcium and vitamin D – risk of heart attack
Vitamin D - supplements and testing
Strontium ranelate - risk of blood clots; DRESS; heart attack (now only prescribed in special circumstances
Denosumab – availability & adverse effects
HRT and osteoporosis
Generic drugs

21. Drug treatments
When do I take my drug treatment?
How do I take my drug treatment?
Can I take other treatments at the same time?
What about side effects?
How do I know it is working?
Is a generic drug the same
as a branded version?

28. NOS Helpline provides... Information Support Help
Excellent, independent & free
Unbiased & balanced
Evidence based & up to date
Support
Listening
Caring
Trustworthy
Help
To make informed decisions
To achieve a good quality of life

29. What questions are we asked?

31. ‘Life with Osteoporosis’ Report
Landmark research project intended to promote a greater understanding of the lives of people with osteoporosis
3228 people completed a detailed questionnaire about the real impact of osteoporosis on their quality of life
52 were involved in either face to face interviews or keeping reflective diaries
Many spoke movingly about the devastating consequences which osteoporosis and fragility fractures has had on their lives
There are 5 videocasts on the NOS website which help to shed real light on the life-changing consequences of this silent condition -so I would urge to go online and watch them
I have a some copies of the Report with me today, but please take one if you are interested in finding out more

32. New NOS Service Support Initiatives
Fracture Prevention Practitioner online training programme
1. This online training course aims to enable Fracture Prevention Practitioners (FPPs) to develop their skills in diagnosis, treatment and management of osteoporosis and fragility fracture using nationally agreed best practice standards. Those successfully completing both foundation and advanced modules will receive accreditation as a fracture prevention practitioner
2. This Implementation Toolkit provides a set of tools that support healthcare providers to improve the local care of people with osteoporosis and fragility fractures’ The kit includes a service specification, economic case, evidence library, needs analysis tool, capacity planning tool, quality standards, performance indicators, project planning tool and part-populated business case
3. Small team of clinically expert FLS practitioners who will work with FLS teams across the country to examine current service provision versus best practice, identify any issues, and establish a support framework for service enhancement, including building a business case for commissioning investment
4. The primary objective of peer review is to provide quality assessment and assurance to improve performance based around professional credibility
5. Offers practical advice on implementing QOF, effective case-finding, treatments for osteoporosis and lifestyle tips for patients

33. New NOS Service Support Initiatives
Fracture Liaison Service (FLS) Implementation Toolkit
Fracture Liaison Service: Support Managers
Peer Review
Clinical standards for FLS
Osteoporosis resources for primary care clinicians –online resource supported by RCGP www. osteoporosis-resources.org.uk

34. What is your role? Has your patient had a fracture and is over
50 years old?
Give exercise, nutritional and heath & wellbeing advice, with referral as appropriate
Signpost them to our publications, NOS helpline
Signpost them to Trust services and information including PWT (Trust’s Promoting Wellbeing Team) e.g. smoking cessation clinics, strength and balance classes, falls clinics, falls directory

35. Do they need help with medication compliance?
Make use of the health professional section of the NOS website. Share with your colleagues
Signpost them to our publications
Identification of patients at risk of osteoporosis and who may need a DEXA? - role of the Trust FLS

36. How can we help you? Helpline is also for health professionals
Professional publications e.g. Osteoporosis Review
E-newsletter and website news section
Professional membership of the Charity
UK Allied Health Professional Network
Osteoporosis resources website
Free patient publications and factsheets (downloadable from our website)

38. Contacting the helpline
Telephone: or
(Monday to Friday 9.00 – hours)
(Replied to within 5 working days)
Letter: National Osteoporosis Society,
Camerton, Bath BA2 0PJ
(Replied to within 7 working days)
Discussion Forum: ‘Ask the Nurses’ Forum
(Open for 48 hours a week, replied to within 2 working days)