Can my 67-year-old mom treat her osteoporosis without HRT?

Question

Hello doctor,

My mother is 67 years old and was diagnosed with osteoporosis after her DEXA (Dual energy X-ray absorptiometry) scan showed a T-score of -3.2 in her spine. She has been taking Alendronate (Bisphosphonate) for about eight months, but continues to experience stomach discomfort and heartburn.

She fractured her wrist a few months ago from a minor fall and now feels fearful of engaging in most physical activities. Her calcium levels were low at 8.9 milligrams per deciliter, and her vitamin D was also low at 18 nanograms per milliliter. She has since started taking supplements.

She has been postmenopausal for over 15 years and never received hormone replacement therapy, which her rheumatologist mentioned might have helped prevent the development of osteoporosis.

Currently, she is also experiencing vaginal dryness and painful intercourse, but is hesitant to take any hormone-based treatment because her sister had breast cancer.

Her physical therapist recommended weight-bearing exercises, but she had another fall just last week while walking down the stairs.

Her bone turnover markers, specifically CTX (C-terminal telopeptide of type I collagen), were elevated at 0.8 nanograms per milliliter, indicating rapid bone loss.

Should she consider changing her osteoporosis medication due to gastrointestinal side effects?
Is hormone therapy still a safe option at her age, given her family history of breast cancer?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Your mother, being 67 years old, has been diagnosed with osteoporosis. She has a family history of breast cancer, low calcium and vitamin D levels, and has never been on hormone therapy.

Hormone therapy is typically started at an earlier age in patients who are approaching menopause and do not have any high-risk medical history.

Given your mother’s current age, her known diagnosis of osteoporosis, and a family history of breast cancer, hormone therapy is not the treatment of choice for her. She might have been a suitable candidate had it been initiated earlier, but even then, considering the breast cancer risk, I would have avoided prescribing it.

Currently, based on her health parameters, it is best to continue calcium and vitamin D supplementation.

She should also continue taking Alendronate (Bisphosphonate class). If she is experiencing heartburn or stomach discomfort, this can be managed by using antacids and modifying her food habits. She must remain extremely careful during her daily activities to prevent further falls.

As for vaginal dryness, this is a very common issue in postmenopausal women. I will recommend a vaginal cream containing Estradiol (Estrogen class) to be applied once at night for three months. Additionally, using water-based lubricants during intercourse may help alleviate discomfort.

She should also follow up with an orthopedician for further management of her osteoporosis.

Please follow up after one week for further evaluation and progress review.

I hope this helps.

Thank you.