From the Guidelines
To SOAP a patient with osteoporosis, begin with a thorough Subjective assessment by documenting the patient's symptoms such as back pain, height loss, or fracture history, along with risk factors including age, gender, family history, medication use, and lifestyle factors, as recommended by the most recent guidelines 1. For the Objective component, record physical examination findings like kyphosis or height measurements, and document diagnostic test results, particularly bone mineral density (BMD) from DXA scans, noting T-scores and previous fracture evidence. In your Assessment, clearly state the diagnosis of osteoporosis, its severity based on T-scores (normal: >-1.0, osteopenia: -1.0 to -2.5, osteoporosis: ≤-2.5), fracture risk using FRAX calculations, and identify contributing factors, considering the updated practice guidelines for dual-energy x-ray absorptiometry (DXA) 1. The Plan should include pharmacological interventions such as bisphosphonates (alendronate 70mg weekly, risedronate 35mg weekly), RANK ligand inhibitors (denosumab 60mg subcutaneously every 6 months), anabolic agents (teriparatide 20mcg daily subcutaneous injection), or hormone therapy as appropriate, based on the latest recommendations from the American College of Physicians 1 and the Journal of the American College of Radiology 1. Include calcium (1000-1200mg daily) and vitamin D (800-1000 IU daily) supplementation, lifestyle modifications like weight-bearing exercise and smoking cessation, fall prevention strategies, and a follow-up schedule with BMD reassessment every 1-2 years, as suggested by the European Journal of Nuclear Medicine and Molecular Imaging 1. This structured approach ensures comprehensive documentation and management of osteoporosis, addressing both the underlying bone density issues and fracture prevention through appropriate interventions, ultimately prioritizing morbidity, mortality, and quality of life outcomes. Key considerations include:
- Using DXA scans for BMD measurement, with T-scores and Z-scores as diagnostic tools 1
- Assessing fracture risk with FRAX calculations and considering contributing factors such as age, gender, and family history 1
- Implementing pharmacological and lifestyle interventions to prevent fractures and improve bone density, based on the most recent guidelines and evidence 1
From the Research
Assessment of a Patient with Osteoporosis using the SOAP Method
- The SOAP method is a widely used framework for assessing patients, and it consists of four components: Subjective, Objective, Assessment, and Plan 2.
- When assessing a patient with osteoporosis using the SOAP method, the following information should be gathered:
- Subjective: personal and family history of fractures, lifestyle, intake of substances such as vitamin D, calcium, corticosteroids, and other medications 3.
- Objective: physical examination to reveal relevant information such as height loss and risk of falls, laboratory testing, and imaging studies such as dual-energy x-ray absorptiometry (DEXA) scans to evaluate bone mineral density (BMD) 3, 4.
- The Assessment component of the SOAP method involves interpreting the gathered information to determine the patient's condition and develop a plan for treatment.
- The Plan component of the SOAP method involves developing a comprehensive plan to reduce the patient's fracture risk and improve their quality of life.
- This plan may include pharmaceutical treatments such as bisphosphonates, denosumab, and hormonal therapies, as well as preventative measures such as tailored exercise and sufficient intake of calcium and vitamin D 4.
- The plan should be individualized to the patient's specific needs and should take into account their medical history, physical examination findings, and BMD test results 3, 5.