The osteoporosis clinic, assessed and treated in one visit.

Prices vary by clinic, by consultant, and by whether teriparatide or romosozumab is used. Most PMI policies cover consultation, DEXA and standard drug therapy when medically indicated - anabolics are often self-pay.

1. 01

   Before

   You send the DEXA or fracture history

   A short, confidential form. Prior DEXA, any fragility fracture, height loss, steroid use, menopause status, family history and current medication.

2. 02

   Before

   We come back with a recommendation

   Within one working day: which clinician fits, whether a new DEXA and VFA are needed, and an indicative price. An honest read either way.

3. 03

   Before

   We book the clinic and DEXA

   Usually within one to two weeks. DEXA of hip and spine (and forearm if hyperparathyroidism is suspected), bloods, and consultant review on the same visit where possible.

4. 04

   On the day

   Assessment at the clinic

   DEXA, VFA vertebral fracture assessment and TBS adjunct. Bloods for vitamin D, calcium, PTH, TSH, U&E, LFT, FBC and myeloma screen. Height, falls and medication review.

5. 05

   On the day

   FRAX and treatment discussion

   The consultant walks you through your 10-year fracture risk (FRAX), the NOGG intervention thresholds, and the treatment ladder that fits - oral, IV, denosumab or an anabolic.

6. 06

   On the day

   Prescription or infusion booked

   Oral bisphosphonate on the same day; IV zoledronate or ibandronate booked as a day-case; denosumab, teriparatide or romosozumab arranged with the specialist nurse.

7. 07

   After

   Follow-up and drug-holiday review

   DEXA at 2-3 years on treatment. Bisphosphonate reassessment at 5 years (oral) or 3 years (IV) for a drug holiday. Denosumab is never stopped without a bisphosphonate bridge.

• Postmenopausal women over 50

  The largest group. FRAX and DEXA guide whether oral bisphosphonate, IV, denosumab or an anabolic fits - and whether HRT should sit alongside.

• Prior fragility fracture (hip, spine, wrist)

  A single fragility fracture over age 50 is an indication for treatment regardless of DEXA - and a trigger for a fracture liaison service (FLS) referral.

• Long-term oral glucocorticoids

  Prednisolone 7.5 mg or more daily for 3 months or longer - treat early, often before DEXA thresholds are crossed, per NOGG guidance.

• Early menopause or POI

  Menopause before 45 (natural or surgical) accelerates bone loss. HRT is usually first-line for bone protection until the average age of menopause.

• Aromatase inhibitor or androgen deprivation

  Breast cancer AIs (letrozole, anastrozole) and prostate cancer ADT (goserelin, leuprorelin) drive rapid bone loss. Zoledronate or denosumab is standard.

• Height loss or thoracic kyphosis

  Loss of 4 cm or more from young-adult height, or new kyphosis, needs a VFA or spine X-ray - occult vertebral fractures change the treatment ladder.

• Suspected secondary osteoporosis

  Coeliac, hyperparathyroidism, hyperthyroidism, hypogonadism, myeloma and CKD-MBD - the workup goes beyond DEXA before any drug is chosen.

• Red flag: severe back pain + height loss

  Sudden severe back pain, height loss or neurological signs need urgent imaging for a vertebral fracture or, rarely, a myeloma or metastasis - not a routine booking.

• Oral bisphosphonate upper-GI upset

  Take on an empty stomach with plain water, stay upright for 30-60 minutes. Reflux, oesophagitis and dysphagia are the commonest reasons to move to IV therapy.

• Zoledronate acute-phase reaction

  Flu-like symptoms, fever and myalgia for 1-3 days after the first infusion, in around 30% of patients. Paracetamol before and after helps; rare after later infusions.

• Denosumab rebound fracture risk

  Stopping denosumab without a bisphosphonate bridge causes rapid bone loss and a spike in multiple vertebral fractures within 12 months. Never miss a dose without a plan.

• Osteonecrosis of the jaw (ONJ)

  Rare (around 1 in 10,000 on oral, 1 in 1,000 on IV or denosumab). A dental check and any needed extractions before starting IV or denosumab reduces the risk.

• Atypical femoral fracture (AFF)

  Very rare on long-term bisphosphonates or denosumab. Thigh or groin pain that persists needs an X-ray - drug holidays after 5 years (oral) or 3 years (IV) reduce risk.

• Hypocalcaemia before IV or denosumab

  Corrected calcium and vitamin D are checked before any IV bisphosphonate or denosumab dose. Vitamin D deficiency is corrected first; hypocalcaemia is a contraindication.

• Teriparatide contraindications

  Not for prior skeletal radiotherapy, active malignancy, Paget disease, unexplained raised alkaline phosphatase or severe renal impairment. A 24-month lifetime cap.

• Romosozumab cardiovascular caution

  A small excess of MI and stroke was seen in one trial. Not for patients with recent MI or stroke - the consultant will risk-assess before prescribing.

• Vitamin D, calcium, exercise, falls

  The scaffolding around any drug: vitamin D 800-2000 IU, calcium 700-1200 mg daily, weight-bearing and resistance exercise, Otago falls programme, smoking and alcohol.