From the Guidelines
For a 75-year-old female with newly diagnosed osteoporosis on DEXA scan, I recommend starting bisphosphonate therapy, specifically alendronate (Fosamax) 70mg orally once weekly, as it is a well-established treatment for preventing fractures in men and women with osteoporosis, as stated in the American College of Physicians' clinical practice guideline update 1.
Treatment Overview
The treatment aims to prevent bone resorption and increase bone density, thereby reducing fracture risk. Bisphosphonates, such as alendronate, are the most commonly used medications for osteoporosis treatment. According to the study published in the Annals of Internal Medicine 1, bisphosphonates are effective in preventing fractures in men and women with osteoporosis.
Medication and Supplement Regimen
To effectively manage osteoporosis, I recommend the following regimen:
- Alendronate (Fosamax) 70mg orally once weekly, taken first thing in the morning with a full glass of water, remaining upright for at least 30 minutes before eating or taking other medications.
- Calcium 1200mg daily (divided doses) to support bone health.
- Vitamin D 800-1000 IU daily to enhance calcium absorption and bone mineralization.
Lifestyle Modifications
In addition to medication and supplements, the following lifestyle modifications are essential:
- Weight-bearing exercises like walking 30 minutes daily to improve bone density and overall health.
- Balance training twice weekly to reduce the risk of falls.
- Fall prevention measures, including removing tripping hazards at home, installing grab bars in bathrooms, ensuring adequate lighting, and wearing supportive footwear.
Monitoring and Follow-up
After 3-5 years of treatment, a follow-up DEXA scan is necessary to evaluate the effectiveness of the treatment regimen. If the patient experiences severe heartburn or difficulty swallowing with alendronate, alternative medications like zoledronic acid (annual IV infusion) or denosumab (Prolia, subcutaneous injection every 6 months) may be considered, as mentioned in the study 1.
From the Research
Osteoporosis Diagnosis and Treatment
- A 75-year-old female with a new DEXA scan showing osteoporosis is diagnosed based on a T-score ≤ -2.5 found in the spine, the neck of the femur, or during a full hip examination, as defined by the WHO criteria 2.
- Osteoporosis is a metabolic disease of the skeletal system that affects over 200 million patients worldwide, considerably reducing a patient's quality of life 2.
Risk Factors and Prevention
- Potentially modifiable risk factors for osteoporosis include vitamin D deficiency, smoking, alcohol consumption, low calcium intake, and a sedentary lifestyle or lack of mobility 2.
- Education and prevention of the disease play a major role in managing osteoporosis, and a proper diet, healthy lifestyle, and dietary supplements can significantly inhibit the progression of osteoporosis 2.
- Non-pharmacologic measures such as good nutrition, regular physical activity, and avoiding smoking and excessive alcohol consumption are recommended for all postmenopausal women 3.
Treatment Options
- Pharmaceutical treatment for osteoporosis involves bisphosphonates, calcium and vitamin D3, denosumab, teriparatide, raloxifene, and strontium ranelate 2.
- Other methods of treatment include exercise, kinesitherapy, treatment at a health resort, physical therapy, and diet 2.
- For women with osteoporosis, lifelong management is necessary, and treatment decisions should be individualized and include the patient in the process of shared decision-making 3.
- The Agency for Healthcare Research and Quality (AHRQ) has published a review on the comparative effectiveness of treatments for osteoporosis, including bisphosphonates, parathyroid hormone, teriparatide, calcitonin, estrogens, and denosumab 4.
Adherence and Efficacy
- Adherence to osteoporosis medications varies depending on patient age, prior history of fracture, dosing frequency, concomitant use of other medications, and adverse effects 4.
- High-strength evidence supports a reduction in the risk of vertebral, nonvertebral, and hip fractures in postmenopausal women with osteoporosis treated with certain agents, including alendronate, risedronate, zoledronic acid, or denosumab 4.
- Calcium and vitamin D treatment can reduce the risk of fracture in elderly women, but the evidence is mixed for other populations 4.