Osteoporosis — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 66 of 2024

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting osteoporosis or death from osteoporosis with the circumstances of a person's relevant service:

1. (1)
   being a prisoner of war before clinical onset or clinical worsening;
2. (2)
   having one of the following autoimmune diseases for at least the 1 year before clinical onset or clinical worsening; (a) ankylosing spondylitis; (b) dermatomyositis; (c) psoriatic arthritis; (d) rheumatoid arthritis; (e) systemic lupus erythematosus; or (f) systemic sclerosis;
3. (3)
   having human immunodeficiency virus infection for at least the 1 year before clinical onset or clinical worsening;
4. (4)
   having multiple sclerosis or Parkinson disease for at least the one year before clinical onset or clinical worsening;
5. (5)
   having chronic renal impairment with a glomerular filtration rate of <45 ml/min/1.73 m2 for at least 3 months before clinical onset or clinical worsening;
6. (6)
   having myeloma, non-Hodgkin lymphoma, Hodgkin lymphoma or systemic mastocytosis at the time of clinical onset or clinical worsening;

   Note: systemic mastocytosis is defined in the Schedule 1 - Dictionary.

7. (7)
   having a solid organ (excluding corneal transplant), stem cell or bone marrow transplantation before clinical onset or clinical worsening;
8. (8)
   having one of the following endocrine abnormalities for a continuous period of at least 1 year within the 10 years before clinical onset or clinical worsening; (a) Cushing syndrome; (b) Graves disease; (c) hyperprolactinaemia; (d) hyperthyroidism or thyrotoxicosis; (e) hypogonadism (including menopause); (f) primary hyperparathyroidism; or (g) type 1 diabetes mellitus;
9. (9)
   having one of the following gastrointestinal diseases at the time of clinical onset or clinical worsening; (a) chronic exocrine pancreatic insufficiency; (b) cirrhosis of the liver; (c) coeliac disease; or (d) inflammatory bowel disease;
10. (10)
    having total or partial gastrectomy or a Roux-en-Y gastric bypass at least 1 year before clinical onset or clinical worsening;
11. (11)
    for a minimal trauma fracture only, being pregnant within the 6 months before clinical onset;
12. (12)
    having anorexia nervosa before clinical onset or clinical worsening;

    Note: anorexia nervosa is defined in the Schedule 1 - Dictionary.

13. (13)
    taking one of the following glucocorticoids orally, intravenously or intramuscularly before clinical onset or clinical worsening: (a) betamethasone to a cumulative quantity of at least 60 mg within 6 months, or a cumulative quantity of at least 360 mg over any duration; (b) cortisone to a cumulative quantity of at least 2,500 mg within 6 months, or a cumulative quantity of at least 15,000 mg over any duration; (c) dexamethasone to a cumulative quantity of at least 75 mg within 6 months, or a cumulative quantity of at least 450 mg over any duration; (d) hydrocortisone to a cumulative quantity of at least 2,000 mg within 6 months, or a cumulative quantity of at least 12,000 mg over any duration; (e) methylprednisolone to a cumulative quantity of at least 400 mg within 6 months, or a cumulative quantity of at least 2,400 mg over any duration; (f) paramethasone to a cumulative quantity of at least 200 mg within 6 months, or a cumulative quantity of at least 1,200 mg over any duration; (g) prednisolone to a cumulative quantity of at least 500 mg within 6 months, or a cumulative quantity of at least 3,000 mg over any duration; (h) prednisone to a cumulative quantity of at least 500 mg within 6 months, or a cumulative quantity of at least 3,000 mg over any duration; or (i) a combination of glucocorticoids as weighted by dose equivalent to prednisolone, to a cumulative quantity of at least 500mg within 6 months, or a cumulative quantity at least 3,000 mg;

    Note: drug dose equivalence to prednisolone is defined in the Schedule - 1 - dictionary.

14. (14)
    taking a medication from the specified list before clinical onset or clinical worsening;

    Note: taking a medication from the specified list is defined in the Schedule 1 - Dictionary.

15. (15)
    smoking at least 10 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before clinical onset or worsening, and where smoking has ceased, clinical onset or clinical worsening has occurred within 20 years of cessation;

    Note: one pack-year is defined in the Schedule 1 - Dictionary.

16. (16)
    for males only, drinking at least 150 kilograms of alcohol within any 10 year period within the 20 years before clinical onset or worsening;

    Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.

17. (17)
    for females only, drinking at least 75 kilograms of alcohol within any 10 year period within the 20 years before clinical onset or worsening;

    Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.

18. (18)
    having an altered dietary pattern resulting in a decrease in average daily calcium intake to 400 milligrams per day or less, for a period of at least 2 years before age 20 years, or for a period of at least 7 years after age 20 years, or the equivalent combination thereof, before clinical onset or clinical worsening;
19. (19)
    consuming on average at least 7.5 milligrams per day of vitamin A over a period of at least 2 years within the 10 years before clinical onset or worsening;
20. (20)
    having severe vitamin C deficiency within the 10 years before clinical onset or clinicalworsening;

    Note: severe vitamin C deficiency is defined in the Schedule 1 - Dictionary.

21. (21)
    having vitamin D deficiency, with a serum 25(OH)D level of less than 50 nanomoles per litre, for a continuous period of at least 1 year within the 10 years before clinical onset or clinical worsening;
22. (22)
    having haemochromatosis at the time of clinical onset or clinical worsening;
23. (23)
    being exposed to cadmium at levels which have resulted in: (a) renal damage; or (b) a urinary cadmium level of at least 0.5 micrograms per gram creatinine for a period of at least 5 years, before clinical onset or clinical worsening;
24. (24)
    having gross diminution or near complete absence of movement of the body, such as would occur as a result of paralysis or strict bed rest for at least 3 months within the 2 years before clinical onset or clinical worsening;
25. (25)
    an inability to undertake any physical activity greater than 3 METs for at least the 5 years before clinical onset or clinical worsening;

    Note: MET is defined in the Schedule 1 - Dictionary.

26. (26)
    having a BMI of less than 20 for a continuous period of at least 1 year within the 10 years before clinical onset or clinical worsening;

    Note: BMI is defined in the Schedule 1 - Dictionary.

27. (27)
    losing 10 % or more of body weight in any consecutive 3 year period when aged 50 years or older, within the 10 years before clinical onset or clinical worsening;
28. (28)
    inability to obtain appropriate clinical management for osteoporosis before clinical worsening;