How to manage postmenopausal osteoporosis at 62 years of age?

Question

Hello doctor,

I am a 62-year-old woman with postmenopausal osteoporosis. My recent DEXA scan showed a T-score of –2.9 at the lumbar spine. I am currently taking Alendronate along with calcium and vitamin D supplements, but I have been experiencing severe gastric irritation.

Are injectable treatments such as Denosumab better tolerated? I also have mild chronic kidney disease (eGFR 52). Should I continue with the same medication, or would it be better to switch to another treatment option?

Please advise.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for your query. I understand your concern regarding gastric irritation while managing osteoporosis.

A T-score of –2.9 confirms osteoporosis, and continuing anti-osteoporosis treatment is important to reduce fracture risk. Oral Alendronate commonly causes stomach irritation, and if your symptoms persist despite taking it correctly (on an empty stomach, with a full glass of water, and remaining upright for at least 30 minutes), switching therapy is a reasonable consideration.

Denosumab is an injectable option given as a subcutaneous injection once every six months. It is generally better tolerated from a gastrointestinal standpoint, as it does not irritate the stomach. It is also considered safe in mild chronic kidney disease (estimated glomerular filtration rate (eGFR) 52), though calcium and vitamin D levels should be monitored. Importantly, Denosumab should not be stopped abruptly without appropriate follow-up treatment.

Other options include intravenous bisphosphonates (used cautiously in chronic kidney disease) and anabolic agents in high-risk cases. I recommend checking your serum calcium and vitamin D levels and discussing a possible switch to Denosumab with your physician, given your persistent gastric symptoms. It is also essential to ensure a clear long-term treatment plan before making any medication changes.

Switching to an injectable therapy is a reasonable option in your situation if gastric intolerance continues. Please let me know how long you have been taking Alendronate and whether you have experienced any fractures.

I would appreciate your valuable feedback, as it may help other patients with similar concerns.

Thank you.