Which drug is best for my high fracture risk?

Question

Hello doctor,

I recently had a minor fall from standing height and fractured my wrist, which seemed excessive for such a small trauma. This prompted my doctor to order bone density testing. My DEXA scan showed a T-score of negative 3.5 in the spine and negative 3.0 in the hip, where normal is above negative 1.0 and severe osteoporosis is below negative 2.5, indicating a very high fracture risk. I have also lost about two and a half inches in height over the past twelve years and developed a noticeable forward curve in my upper back, known as kyphosis.

My mother had severe osteoporosis and fractured her hip at seventy. I experienced early menopause at 44 without taking hormone replacement therapy. My laboratory results showed vitamin D at 16 nanograms per milliliter, where normal is 30 to 100; calcium at 8.0 milligrams per deciliter, where normal is 8.5 to 10.5; parathyroid hormone at 85 picograms per milliliter, where normal is 10 to 65; and elevated bone turnover markers.

What causes osteoporosis? What is the difference between osteopenia and osteoporosis? What medications are available, such as bisphosphonates, Denosumab, Teriparatide, and Romosozumab, and which medication would be best for me? What are the side effects, including jaw osteonecrosis and atypical fractures? How long should these medications be taken? Do I need calcium and vitamin D supplements? Which exercises are safe and which are dangerous? What is my fracture risk? Will medication rebuild lost bone, and can osteoporosis be reversed? What should I do if I fall again? Should my daughters be screened early?

Please help.

Thank you.

Answer 1

Hello,

Welcome back to icliniq.com.

I understand your concern.

I am so sorry to hear that you had a fracture. I hope you are recovering well. The elderly population is more susceptible to a Colles fracture, which is a wrist fracture. This typically occurs when falling on an outstretched hand.

I would like you to understand that osteopenia is reduced bone density, whereas osteoporosis is a condition of severe bone loss due to decreased bone density. Osteopenia can progress to osteoporosis over time.

In osteoporosis, bone density is very low, making one more susceptible to fractures. This is defined by a T-score of negative 2.5 or lower. In your case, you also have osteoporosis.

Menopause leads to the withdrawal of estrogen and progesterone, which makes your bones more vulnerable to bone loss. You will need to ensure adequate calcium and vitamin D intake through diet as well as supplements.

Osteoporosis treatment includes bisphosphonate drugs, Denosumab, or anabolic agents like Teriparatide. These medications are available in injectable as well as oral forms. Your doctor will decide which medicine is best based on your ability to follow the treatment. Teriparatide injections are taken subcutaneously for over a year.

Until your bone health improves, you must be careful while walking and monitor your exercise due to the risk of fractures.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.