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.

An osteoporosis diagnosis is made when one has a T score of –2.9, and therefore it becomes necessary to continue the anti-osteoporosis medications to avoid fractures. Alendronate oral tablets may cause irritation in the stomach, and if you experience this despite having followed all the instructions in taking the medication, changing therapy is a viable option.

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.

In other instances, IV bisphosphonates and anabolic drugs may be considered when there is a high risk involved. I would advise you to have your serum calcium and vitamin D levels evaluated by your doctor to see if there could be a possibility of using Denosumab based on your gastric symptoms. In any case, it is vital to establish the correct treatment regimen for the future.

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.