I have osteoporosis. How do I prevent fractures at 59?

Question

Hello doctor,

I am 59 and was just told I have severe osteoporosis after breaking my wrist from just catching myself when I tripped. My bone density scan showed a T-score of -3.8 in the spine and -3.2 in the hip, which the doctor says is really dangerous.

I have been in menopause since age 52 and never took hormone replacement because I was scared of breast cancer risk.

Now I wish I had because my bones are like Swiss cheese, according to the radiologist. My mom had osteoporosis too and broke her hip at 70; she has been in a wheelchair ever since.

The endocrinologist wants me to start Reclast infusion, but I read terrible things online about jawbone death and fractures. I am only 5 feet 2 inches and have lost 2 inches in height over the past five years, which I thought was normal aging, but apparently, my spine has compression fractures from osteoporosis.

My vitamin D was only 14, and calcium was low-normal. I tried taking Alendronate pills, but they gave me horrible reflux and stomach pain. Also, I have rheumatoid arthritis and have been on Prednisone on and off for 10 years, which the doctor says contributed to osteoporosis.

I am scared. What treatment options are there that will not destroy my jaw or cause more fractures?

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

A wrist fracture from a simple fall, combined with T scores of minus 3.8 in the spine and minus 3.2 in the hip, means this is severe osteoporosis, and the height loss and compression fractures explain why your back has been changing over time.

This is not a personal failure or something you caused by avoiding hormone therapy. Many women make that choice out of reasonable concern, and long-term Prednisone use for rheumatoid arthritis is a very strong and well-known contributor to bone loss, even when everything else is done right.

The important thing now is that effective and safe treatments do exist, and doing nothing actually carries the highest risk, especially for hip and spine fractures that can be life-changing.

Reclast, which is Zoledronic acid, is a bisphosphonate given once yearly by infusion and is often recommended when oral medications like Alendronate cause stomach pain or reflux.

The complications you read about, such as jawbone death and unusual thigh fractures, are real but extremely rare, especially in people being treated for osteoporosis rather than cancer.

For someone with fractures and very low bone density, the benefit of preventing hip and spine fractures is far greater than the small risk of these side effects. Some treatment options are:

Good dental care, treating vitamin D deficiency before infusion, and regular monitoring dramatically reduce the risk.
Another important option is anabolic therapy, which actually builds new bone rather than just slowing bone loss.
Medications like Teriparatide or Abaloparatide are often used in people with severe osteoporosis, steroid exposure, and fractures like yours, and they are not associated with jaw necrosis.
Romosozumab is another newer option that both builds bone and reduces breakdown, though it must be chosen carefully if there is heart disease.
Many specialists now start with an anabolic agent for one to two years and then transition to a medication like Reclast to maintain the gains.
Correcting your vitamin D level is essential and should be done aggressively, since a level of 14 is very low and by itself increases fracture risk.

A few preventive measures that can help you are:

Adequate calcium intake from diet and supplements.
weight-bearing and balance-focused exercise.
Fall prevention at home.
Minimizing Prednisone exposure.

Your fear of treatment is understandable, especially after seeing what happened to your mother, but the goal of therapy is exactly to prevent that outcome. With the right plan, it is very possible to strengthen your bones, reduce fracture risk, and protect your independence.

For clear guidance and support, discuss these options with your endocrinologist until you feel comfortable moving forward.

I hope this helps.

Thank you.