From the Guidelines
For a patient with a DEXA scan T-score of -2.81, the next step should be to initiate pharmacological treatment for osteoporosis along with lifestyle modifications. First-line medication therapy typically includes bisphosphonates such as alendronate (70 mg orally once weekly), risedronate (35 mg orally once weekly), or zoledronic acid (5 mg IV once yearly) 1. These medications work by inhibiting bone resorption by osteoclasts, thereby increasing bone mineral density and reducing fracture risk. The patient should also take calcium (1000-1200 mg daily) and vitamin D (800-1000 IU daily) supplements. Lifestyle modifications should include:
- Weight-bearing exercise
- Smoking cessation
- Limiting alcohol intake
- Fall prevention strategies A comprehensive metabolic workup should be performed to rule out secondary causes of osteoporosis, including thyroid function tests, serum calcium, vitamin D levels, and renal function. The T-score of -2.81 indicates established osteoporosis (defined as T-score ≤ -2.5), which significantly increases fracture risk, particularly in the spine and hip 1. Treatment efficacy should be monitored with follow-up DEXA scans typically after 1-2 years of therapy, and medication should generally be continued for at least 3-5 years, with periodic reassessment of fracture risk 1. It is essential to note that the World Health Organization defines osteoporosis as a T-score ≤ -2.5, and the National Osteoporosis Foundation recommends pharmacologic treatment for all postmenopausal women and men >50 years of age with a T-score ≤ -2.5 1. In patients with low bone mass, a fracture risk assessment tool, most commonly FRAX, is used to determine the 10-year probability of a hip fracture or a major osteoporosis-related fracture 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Next Steps for a Patient with a DEXA Scan T-score of -2.81
- A DEXA scan T-score of -2.81 indicates osteoporosis, and treatment is necessary to reduce the risk of fractures 2, 3, 4.
- Bisphosphonates, such as alendronate and risedronate, are commonly used to treat osteoporosis and have been shown to increase bone mass and reduce the risk of vertebral and nonvertebral fractures 2, 3, 5.
- The choice of bisphosphonate depends on various factors, including the patient's medical history, tolerance, and preferences 5, 4.
- Risedronate has been shown to be effective in increasing bone mineral density and reducing the incidence of fractures in patients with postmenopausal osteoporosis 5.
- Alendronate and risedronate are considered first-line therapy options for the treatment of postmenopausal osteoporosis, and transitioning to other therapies may be considered if the patient does not respond adequately to these treatments 6.
- Potential alternatives for patients switching from alendronate or risedronate to other therapies include zoledronic acid, strontium ranelate, denosumab, or teriparatide, which may cause further increases in bone mineral density 6.