Primary care management of patients at high risk of fracture: Who to treat? Who to refer?

Together with bone mineral density (BMD), FRAX is used to define fracture risk and identify those patients at the highest risk of fracture and in need of antifracture therapy. At the National Osteoporosis Foundation of South Africa (NOFSA) annual congress hosted in Cape Town during November 2025, Dr Zane Stevens shared his practical experience of initiating antifracture therapy as illustrated by the case of Mrs RP, referred for a bone health assessment: Which drug for which patient? When should a patient be referred to a colleague who is more experienced in managing metabolic bone disease?

You will gain an understanding of:

• The life-course approach to the management of osteoporosis
• The principles of osteoporosis management
• How to select a first-line therapy for the treatment of osteoporosis where there is a high or very high/imminent risk of fracture
• The impact of discontinuing antifracture treatments on bone turnover, bone loss and fracture
• Clinical evidence supporting best approaches to sequential management of antifracture therapies in people at high and very high/imminent risk of fracture.

Dr Zane Stevens
Specialist Physician and Endocrinologist at Cape Institute of Endocrinology

He is in endocrine private practice at Christiaan Barnard Memorial Hospital, Cape Town, with a specific interest in diabetes, thyroid disease and osteoporosis. He was the previous Associate consultant/lecturer in the Division of Endocrinology at Stellenbosch University & UCT involved in undergraduate and postgraduate training in Internal Medicine and Endocrinology. He is also a member of the task force for creating and publishing South African Hypothyroidism guidelines 2015. Dr Stevens is the co-author of the Insulin chapter in the 2017 SEMDSA guidelines for the management of type 2 DM and is also the co-author of the Endocrine chapter in Tropical Handbook of Medicine 5th edition. He is the executive council member of the South African National Osteoporosis Foundation (NOFSA). Specific interest in Fracture Liaison Services (FLS). He is also the South African Colleges of Medicine examiner for the sub specialization in Endocrinology & Metabolism (FCP). Dr Stevens is the founding member of the Cape Thyroid Forum MDT for thyroid cancers and combined structural/functional thyroid disease and has served on several local and international advisory boards for various pharmaceutical companies. He is currently speaks/lectures