Marrow is a specialist osteoporosis clinic that reads bone density scans the way a cardiologist reads an ECG — with the depth that changes outcomes.
Whether your GP flagged a T-score below −2.5, you fractured a wrist from a standing fall, or a parent's compression fracture changed everything overnight — this is where the real conversation begins.
T-score ≤ −2.5
Postmenopausal women referred by GP
Fragility fracture
Men 60+ who fractured from a low fall
Caring for a parent
Adult children after a compression fracture
4-specialist multidisciplinary team · DXA scan interpretation
What your GP manages.
What we treat.
Four specialists. Four dimensions where the difference between standard care and specialist care is measurable in fractures prevented. Hover any cell — every expert has something to say.
Dr. Catherine Marsh
Endocrinologist
“Hormone-driven bone loss is the most under-diagnosed mechanism in postmenopausal women. A DXA number alone misses the story.”
| Dimension | Standard GP Management | ✦ Marrow Specialist Care |
|---|---|---|
Scan Interpretation Depth | — T-score read, category assigned Standard GP workflow: T-score below −2.5 triggers referral or bisphosphonate initiation. The scan is read, not interrogated. | ✓ Trabecular bone score, rate of change, vertebral fracture assessment We layer TBS analysis onto DXA to assess bone microarchitecture. A T-score of −2.6 with poor TBS carries 3× the fracture risk of the same score with intact microarchitecture. “Two patients with identical T-scores can have wildly different fracture risk. The microarchitecture is what separates them — and you can only see it if you know to look.” — Dr. Catherine Marsh, Endocrinologist |
Hormone Assessment | — Not routinely ordered Bone loss is rarely traced to its hormonal origin in a GP consult. Secondary causes are missed in up to 30% of osteoporosis cases. | ✓ Full endocrine panel: FSH, oestradiol, PTH, vitamin D, cortisol Secondary osteoporosis (hyperparathyroidism, subclinical Cushing's, malabsorption) accounts for a third of our new patients. We find it because we test for it systematically. “I've diagnosed hyperparathyroidism in women who'd been on bisphosphonates for six years. The medication was masking the real problem.” — Dr. Catherine Marsh, Endocrinologist |
Fracture Risk Modelling | — FRAX score, 10-year probability FRAX is a validated tool but uses only 12 input variables. It cannot account for bone microarchitecture, fall mechanics, or medication interactions. | ✓ FRAX + TBS adjustment + falls risk + lifestyle modifiers We adjust FRAX with TBS, overlay falls risk from physiotherapy assessment, and model medication efficacy based on individual bone turnover markers. The result is a personalised fracture probability, not a population average. “Standard FRAX underestimates risk in women with poor trabecular bone score by up to 40%. That's the difference between treatment and watchful waiting.” — Dr. Catherine Marsh, Endocrinologist |
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Now you know what you didn't know.
The Marrow Bone Health Guide explains every dimension in this table — in plain language, with the questions to ask your doctor at your next appointment.
- ✓Understanding your DXA report (T-score, Z-score, TBS)
- ✓Medication options explained without jargon
- ✓The 5 questions to ask before starting treatment
- ✓What to eat, what to lift, what to avoid
Dr. James Okafor
Rheumatologist
“Medication choice in osteoporosis is not one-size-fits-all. The difference between a bisphosphonate and a RANK-L inhibitor can be a second fracture.”
| Dimension | Standard GP Management | ✦ Marrow Specialist Care |
|---|---|---|
Medication Options | — First-line bisphosphonate (alendronate) Alendronate is the correct first-line choice for most patients. But it's often continued unchanged for years without reassessing bone turnover markers or fracture risk trajectory. | ✓ Full formulary: bisphosphonates, denosumab, teriparatide, romosozumab We match medication class to bone turnover rate, fracture history, and comorbidities. High-risk patients with recent vertebral fracture may need anabolic agents first — the opposite of standard sequencing. “A patient who fractures on alendronate after three years isn't a treatment failure. They're a patient who needed a different drug from the start — one their GP couldn't prescribe.” — Dr. James Okafor, Rheumatologist |
Monitoring & Response | — Repeat DXA at 2 years A 2-year DXA repeat tells you what happened. Bone turnover markers at 3 months tell you if the medication is working — before you've lost another year. | ✓ Bone turnover markers at 3 months, DXA at 18 months, FRAX recalculation P1NP and CTX-1 markers at 3 months confirm treatment response. Non-responders are identified and switched before a second fracture occurs. We don't wait for the scan to tell us what the blood already knows. “If CTX-1 hasn't dropped by 50% at three months, the medication isn't working. I change it. Most patients wait two years to find that out from a DXA.” — Dr. James Okafor, Rheumatologist |
Drug Holiday Management | — Rarely discussed proactively Bisphosphonate drug holidays are recommended after 3–5 years for low-risk patients. This conversation rarely happens proactively in general practice. | ✓ Structured cessation protocol with reassessment triggers We plan the drug holiday from day one. Duration, monitoring intervals during cessation, and restart criteria are documented. Atypical femoral fracture risk from prolonged bisphosphonate use is a real and preventable complication. “I've seen atypical femoral fractures in women on alendronate for twelve years because no one ever discussed a holiday. That's not a medication side effect — that's a monitoring failure.” — Dr. James Okafor, Rheumatologist |
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Sarah Nguyen
Specialist Physiotherapist
“The fall is the event. The bone is the victim. Exercise prescription that prevents falls is as powerful as any medication — when it's specific enough.”
| Dimension | Standard GP Management | ✦ Marrow Specialist Care |
|---|---|---|
Exercise Prescription | — General advice: weight-bearing exercise, avoid falls "Stay active and do weight-bearing exercise" is correct but insufficient. Without specificity — load, frequency, progression, contraindicated movements — it's advice that patients cannot act on safely. | ✓ Individualised progressive resistance + balance + impact programme We prescribe exercise like medication: specific loads, sets, rest periods, and progression schedules. LIFTMOR-M protocol for high-risk patients. Contraindicated movements (forward flexion, spinal loading) documented for each individual. “Yoga is wonderful — unless you have a T12 compression fracture, in which case forward flexion is reinjuring you every morning. Specificity is the difference between exercise helping and exercise harming.” — Sarah Nguyen, Specialist Physiotherapist |
Falls Risk Assessment | — Not routinely performed Falls risk is the proximate cause of most osteoporotic fractures. Without formal assessment, it remains invisible in the clinical record. | ✓ TUG test, 4-stage balance, gait analysis, home hazard review Timed Up and Go, Four-Stage Balance Test, and gait analysis at every new patient assessment. Falls risk score is integrated into the fracture probability model. Home hazard checklist sent before first appointment. “A TUG time over 12 seconds doubles hip fracture risk independent of bone density. That's a modifiable risk factor we can act on immediately — but only if we measure it.” — Sarah Nguyen, Specialist Physiotherapist |
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Marcus Reid
Clinical Dietitian
“Calcium from food behaves differently to calcium from supplements. Absorption depends on vitamin D status, gut microbiome, and protein intake — none of which a standard dietary handout addresses.”
| Dimension | Standard GP Management | ✦ Marrow Specialist Care |
|---|---|---|
Calcium & Vitamin D | — Supplement recommendation (1000mg Ca, 1000IU D3) Standard supplementation advice is evidence-based for populations. For individuals, it misses malabsorption, dietary calcium adequacy, and the fact that calcium supplements above 500mg/day may increase cardiovascular risk. | ✓ Dietary calcium audit, 25-OH-D level, personalised supplementation dose We measure 25-OH-D and adjust supplementation to achieve a target serum level of 75–100 nmol/L — not a generic dose. Dietary calcium audit identifies whether supplementation is even needed. Calcium from food is always preferred. “I've seen patients on 1000mg calcium supplements who are getting 1400mg from diet already. More isn't better — it's potentially harmful. Measurement before prescription.” — Marcus Reid, Clinical Dietitian |
Protein & Muscle Mass | — Not addressed in osteoporosis management Bone and muscle are mechanically coupled. Sarcopenia (low muscle mass) is present in 30% of osteoporosis patients and dramatically amplifies fracture risk — yet it's invisible in standard bone care pathways. | ✓ Protein intake audit, sarcopenia screening, muscle-bone interaction plan We screen for sarcopenia at every assessment. Protein prescription (1.2–1.6g/kg/day) is integrated with the exercise plan. Leucine-rich protein timing around resistance training sessions is specified. Muscle-bone interaction is the foundation of our physical resilience programme. “You cannot build bone without building muscle. They share the same mechanical load. Treating one without the other is like fixing one leg of a table.” — Marcus Reid, Clinical Dietitian |
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4,200+
DXA Scans Reviewed
since 2018
340+
Fractures Prevented
modelled at 5-year follow-up
4
Specialist Team
disciplines in one clinic
+0.18
Median T-score Improvement
at 24-month review
Four specialists. One conversation.
Dr. Catherine Marsh
Endocrinologist
FRACP · MBBS (Hons) · 18 years specialist practice
Dr. James Okafor
Rheumatologist
FRACP · PhD Bone Metabolism · Royal Melbourne Hospital
Sarah Nguyen
Specialist Physiotherapist
APAM · Cert. IV Osteoporosis Exercise · LIFTMOR-trained
Marcus Reid
Clinical Dietitian
APD · MSc Nutritional Medicine · Bone Health Specialist
“A bone density number is a starting point. The treatment plan is what happens when four specialists read it together.”
— The Marrow Clinical Team
Check your fracture
risk in 2 minutes.
This is not a diagnosis. It's a structured conversation starter — the same questions a specialist would ask in your first five minutes. Your score ends with a personalised recommendation.
1 in 3
Women over 50 will fracture due to osteoporosis
1 in 5
Men over 50 will fracture due to osteoporosis
30%
Of cases have a secondary, treatable cause missed at GP level
Fracture Risk Screener
7 questions · 2 minutes · Personalised recommendation