Statement of Principles concerning osteoporosis (Reasonable Hypothesis) (No. 66 of 2024) (Cth)

Statement of Principles concerning OSTEOPOROSIS (Reasonable Hypothesis) (No. 66 of 2024) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 20 August 2024.

Professor Terence Campbell AM Chairperson by and on behalf of The Repatriation Medical Authority

Contents 1 Name 2 Commencement 3 Authority 4 Repeal 5 Application 6 Definitions 7 Kind of injury, disease or death to which this Statement of Principles relates 8 Basis for determining the factors 9 Factors that must exist 10 Relationship to service 11 Factors referring to an injury or disease covered by another Statement of Principles Schedule 1 - Dictionary 1 Definitions

1 Name This is the Statement of Principles concerning osteoporosis (Reasonable Hypothesis) (No. 66 of 2024). 2 Commencement This instrument commences on 24 September 2024. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning osteoporosis No. 98 of 2014 (Federal Register of Legislation No. F2014L01388) made under subsection 196B(2) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies. 6 Definitions The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument. 7 Kind of injury, disease or death to which this Statement of Principles relates (1) This Statement of Principles is about osteoporosis and death from osteoporosis. Meaning of osteoporosis (2) For the purposes of this Statement of Principles, osteoporosis: (a) means a systemic bone disease characterised by low bone density resulting in a greater susceptibility to fracture (fragility fracture), where low bone mineral density is 2.5 standard deviations or more below the mean bone mineral density of young adult sex-matched controls (T score); or radiologically confirmed fragility fracture or loss of ≥20% of vertebral height due to fragility fractures; and the fragility fracture is not better explained by other types of bone pathology than osteoporosis; or anyone over 70 years with a low bone mineral density; or people with low bone density taking glucocorticoids for at least 3 months; and (b) excludes: (i) localised osteoporosis; (ii) Paget disease of bone; (iii) osteomalacia; (iv) osteonecrosis; (v) osteomyelitis; (vi) malignant or benign neoplasm of bone; and (vii) osteogenesis imperfecta. Note: low bone mineral density is defined in schedule 1 - Dictionary. (3) While osteoporosis attracts ICD‑10‑AM codes M80, M81 or M82, in applying this Statement of Principles the meaning of osteoporosis is that given in subsection (2). (4) For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4. Death from osteoporosis (5) For the purposes of this Statement of Principles, osteoporosis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's osteoporosis. Note: terminal event is defined in the Schedule 1 – Dictionary. 8 Basis for determining the factors The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that osteoporosis and death from osteoporosis can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces under the VEA, or members under the MRCA. Note: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary. 9 Factors that must exist 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) being a prisoner of war before clinical onset or clinical worsening; (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) having human immunodeficiency virus infection for at least the 1 year before clinical onset or clinical worsening; (4) having multiple sclerosis or Parkinson disease for at least the one year before clinical onset or clinical worsening; (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) 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) having a solid organ (excluding corneal transplant), stem cell or bone marrow transplantation before clinical onset or clinical worsening; (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) 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) having total or partial gastrectomy or a Roux-en-Y gastric bypass at least 1 year before clinical onset or clinical worsening; (11) for a minimal trauma fracture only, being pregnant within the 6 months before clinical onset; (12) having anorexia nervosa before clinical onset or clinical worsening; Note: anorexia nervosa is defined in the Schedule 1 – Dictionary.