Are there stomach-safe treatments for severe osteoporosis?

Question

Hello doctor,

I am reaching out because I am feeling quite concerned and would appreciate your guidance. I am 55 years old and was recently diagnosed with severe osteoporosis after sustaining a spinal compression fracture last month from simply bending down to pick up a laundry basket. My recent DEXA scan showed a T-score of -3.8 in the lumbar spine and -3.2 in the hip, which I understand places me at high fracture risk.

I entered surgical menopause at age 42 following bilateral oophorectomy for endometriosis and did not take hormone replacement therapy due to concerns about breast cancer, as my mother had breast cancer. I have since learned that my calcium intake has been inadequate, and my vitamin D level was recently measured at 15 ng/mL.

My endocrinologist has recommended starting Risedronate injections; however, I am already managing multiple medications for thyroid disease and hypertension. I also have significant acid reflux and am concerned about potential gastrointestinal side effects, as I have read that bisphosphonates can exacerbate these symptoms.

At present, my back pain is quite severe. I am unable to stand for more than 10 minutes to prepare meals, my sleep has been significantly affected, and I have noticed a loss of approximately two inches in height over the past few years. I am feeling anxious about the possibility of future fractures.

Given these factors, I wanted to ask whether there are alternative osteoporosis treatment options that may be effective but easier on the stomach. I would greatly appreciate your thoughts on how best to proceed.

Thank you very much for your time and care

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

There are better treatment choices that would better meet your needs based on your clinical situation (attachment removed to protect patient’s identity). If you have a lot of acid reflux, you probably need to stay away from oral bisphosphonates like risedronate tablets because they can make your stomach problems worse.

There are successful alternatives that do not involve eating that go around the stomach:

Injectable treatments that stop bone loss
Every six months, a subcutaneous injection of Denosumab (Prolia) is given. This drug is very successful and does not cause stomach problems.
Reclast (Zoledronic acid), is given once a year through an IV(intravenous).
Treatments that build bone (anabolic).
Many people think these are the best options for people with serious osteoporosis and existing fractures:
Teriparatide or Abaloparatide: daily shots that the patient can give themselves for up to two years; this is usually the first treatment used in high-risk cases.
Romosozumab: needs to be injected once a month for a year; cardiovascular risk assessment is needed before starting.

Along with medication treatment, there are a few other steps that need to be taken right away:

A reading of 15 ng/mL is very low for vitamin D deficiency, and most people need to start treatment right away with a high-dose prescription vitamin D (like 50,000 IU per week), followed by daily maintenance doses.
Calcium intake: It is suggested that you get about 1,200 mg of calcium every day from food and/or pills.
Managing pain: Seeing a pain specialist or physical trainer may help with safe ways to move, taking care of your back, and managing your symptoms.

Since you have reflux and a history of vertebral fractures, it makes sense to talk about starting a more active treatment method that doesn't involve pills, like Prolia or an anabolic agent like teriparatide. Getting rid of your vitamin D shortage right away is also important to keep your bones healthy and greatly lower your risk of breaking them in the future.

I hope this helps.

Thank you.