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sign 142 Management of osteoporosis and the prevention of fragility fractures

Osteoporosis is a common bone disease characterised by reduced bone mass which is associated with an increased risk of low-trauma fractures. In 2013, fractures occurred in 13.2/1,000 women and 6.4/1,000 men over the age of 50 in Scotland. The majority of fractures occur in people above the age of 65 years and a large proportion of these patients have osteoporosis. Fractures are an important cause of morbidity, and patients who suffer hip fractures and vertebral fractures have a decreased life expectancy compared with population-based controls.

A wide range of treatments that can reduce the risk of fractures in patients with osteoporosis is now available. These have the potential to improve clinical outcomes for patients with osteoporosis and to reduce societal costs of medical care associated with fractures.

This guideline provides evidence-based recommendations for best practice in the management of osteoporosis and prevention of fractures. It addresses risk factors for fracture, commonly-used tools for fracture risk assessment, approaches to targeting therapy, pharmacological, and non-pharmacological treatments to reduce fracture risk in different patient groups, treatment of painful vertebral fractures and systems of care.

SIGN 144 Glaucoma referral and safe discharge

The current Scottish General Ophthalmic Services arrangements offer a consistently wider range of clinical tests than are available elsewhere in the UK. They mandate glaucoma-detection strategies but do not incorporate guidance on which patient groups require referral from primary to secondary care.

This guideline provides evidence-based recommendations on the primary-care examination and assessment of patients with suspected glaucoma. Best-practice guidance is provided on which patients should be referred into secondary eye-care services. This guideline also provides guidance on which patients may be discharged from secondary care and safely followed up in the community.

The guideline will be of particular interest to community optometrists, general practitioners and hospital-based health professionals involved in glaucoma care including ophthalmologists, optometrists, specialist nurses and orthoptists. A booklet for patients and their families and carers Glaucoma: what does the SIGN Guideline say?is also available.