What are the safest treatments for my severe osteoporosis?

Question

Hello doctor,

I am 64 years old, and during the DEXA examination, I discovered that I have very advanced osteoporosis in my spine and hips with the values of T-scores being -3.2. This was quite surprising to me, as I have always maintained an active lifestyle and regularly taken calcium supplements.

Last month I fell and broke my wrist. It was a pretty minor fall. My endocrinologist was concerned about my high risk of future spine and hip fractures, which might be a significant health problem. She has been prescribed weekly alendronate, but I have some concerns about the rare but possibly dangerous side effects I have read about, such as osteonecrosis of the jaw and atypical femur fractures.

I hope you could advise me concerning the following issues:

Are there any other drugs, besides bisphosphonates, that could be less harmful or more suitable for my condition?
How effective is the treatment with anti-osteoporosis drugs in reducing the risk of breaking a bone?
Should I look into other methods of treatment of my condition, including the use of denosumab or anabolic therapy?
Which type of physical activity can be recommended for a person with such severe osteoporosis?
Can bone density be increased at all or should I focus only on prevention of bone fracturing and its loss?

Thank you for your time and advice.

Would really appreciate any recommendations you have.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your concern.

It is perfectly natural to have concerns about various options for treatment and side effects. Based on your recent history of wrist fracture and your bone density test results, you are at a very high risk of fractures, particularly in vertebrae and hip bones. Because of this elevated risk, it is important to begin appropriate treatment for osteoporosis.

Treatment decisions are usually based on your bone mineral density (results from your DEXA scan) and your FRAX score (which assesses your risk of a significant osteoporotic fracture in the following 10 years). In general, persons at higher risk are treated earlier and more aggressively.

Bisphosphonates (eg, Alendronate and Risedronate) are one of the most commonly prescribed medications for osteoporosis and have been shown to reduce the risk of fracture. They have been associated with side effects such as jaw osteonecrosis and atypical femur fractures; these are rare and occur in just a small percentage of individuals.

Denosumab is another good treatment that can help reduce the risk of fractures. But it is associated with a similar level of risk of adverse effects and is no safer than bisphosphonate therapy in general. In certain cases, the use of anabolic agents such as Teriparatide, Abaloparatide, and Romosozumab will be indicated, particularly in individuals suffering from severe osteoporosis or a very high risk of fractures. These medications can be highly successful, but they also have their own risks, side effects, and therapeutic considerations.

It is hard to know exactly how much a person’s bone density will increase as a result of treatment. The major goals of therapy are to build bone, reduce the chance of fractures, stop additional bone loss, and maintain quality of life. In some patients, bone density improves over time; however, in others, the main benefit is the stabilization of bone loss and the prevention of future fractures.

Depending on your fracture risk, reaction to therapy, and overall health status, long-term treatment may be needed, perhaps for many years. Work with your healthcare physician for regular follow-up (including periodic screening of bone density) to find the best treatment for you.

I suggest you review the risks and benefits of the various pharmaceutical options with your treating physician so that you may make the best decision together for your particular case.

I hope this explanation was helpful.

If you have any further issues or questions, do not hesitate to come to me.