Tailored care essential in osteoporosis

As the first speaker at the Irish Osteoporosis (IOS) 2025 Annual Medical Conference for Health Professionals, Prof Bernard Walsh, Consultant Physician and Geriatrician, Bone Health Unit, St James’s Hospital, Dublin, and Trinity College Dublin, gave a comprehensive practical presentation entitled: ‘My patient has osteoporosis on DXA – What next?’

He outlined the importance of doing a thorough patient history, a falls assessment, and a full suite of appropriate tests – such as DXA, bone ultrasounds, biochemistry and haematology, etc – to determine the underlying cause. Bone resorption markers can help in the initial assessment of selected patients, are useful for monitoring compliance with bisphosphonates, and possibly for oversuppression of bone turnover, Prof Walsh said.

IOS President Prof Moira O’Brien stated that a major ongoing issue in bone health is that not all causes of bone loss are thoroughly investigated and addressed. She said too often, assumptions are made – for example, in women, bone loss is frequently attributed solely to menopause.

“The issue with this thinking is that the patient will not get the maximum benefit from the medication that they are placed on,” according to Prof O’Brien.

“In my experience, one of the most common causes not addressed is gluten and/or wheat sensitivity. Many people are negative on the coeliac blood test, because unless a person, for example, eats four slices of bread a day for six weeks in order for the test, if sensitive, to be positive. If a person is sensitive to either gluten or wheat, and continues to eat it, it will affect their absorption of nutrients.”

In relation to osteoporosis treatment, Prof Walsh stressed taking an individualised tailored approach with a focus on assessing ‘fracture probability’.

Discussing lifestyle advice for those with bone loss, Prof Walsh said physical activity and weight-bearing exercise is critical, as is not smoking. He also emphasised the importance of adequate calcium intake.

Prof Walsh, who has a specialist interest in the role of vitamin D in bone health, emphasised its importance and impact. He stressed the role of vitamin D deficiency in muscle weakness and increased falls risk and outlined how supplementation can address this issue, using a case study example of a woman successfully treated in St James’s.

He also quoted data showing that vitamin D supplementation appears to reduce the risk of falls among ambulatory or institutionalised older individuals with stable health by more than 20 per cent.

Prof Walsh pointed to the high level of vitamin D insufficiency (<50nmol/l) and deficiency (<30nmol/l) in Ireland, and stressed the need for supplementation.

Prof O’Brien recommends her patients to have a vitamin D level of minimum 70nmol/L, maximum 125nmol/L.

Looking at pharmaceutical therapies for osteoporosis, Prof Walsh noted that beyond calcium and vitamin D intake, bisphosphonates are the backbone of treatment. The National Osteoporosis Guideline Group sets out recommendations on review timelines for the different agents. A patient should not be on bisphosphonates for more than five years, Prof O’Brien noted.

“This means in total – not five years on one brand, five years on another brand.”

For those with more severe disease, Prof Walsh outlined the potency of denosumab, while noting that if it is stopped, there is rapid bone loss.

In terms of surgery, vertebroplasty can be useful for select patients, he said.

Also speaking at the conference was Dr Nicholas Flood, a graduate of the British College of Osteopathic Medicine in London, and Associate Osteopath based in the Osteopathic Life Clinic in Dublin. He discussed the treatment of hot flushes and lack of sleep in pre-/menopausal women by lymphatic techniques.

IOS Annual Medical Conference Abstract winners 2025

Best poster

Perioperative Geriatrician Assessment in Patients presenting with hip fracture

Dr Konrad Timon

Most interesting abstract case

Double Trouble: Two Incomplete Atypical Femoral Fractures in a Single Femur

Dr Anna Christine O’ Hanlon 

Best overall scientific award, as well as a young investigator award

Primary hyperparathyroidism presenting as atraumatic bilateral hip fractures: a case report.

Dr Puteri Maisarah Rameli

Young investigator award

Significant increase in lumbar spine mineral density after adding teriparatide to pre-existing denosumab therapy

Dr Eimear Buckley