From the Guidelines
A T-score of -2.90 indicates osteoporosis, which requires treatment to reduce fracture risk, and I recommend starting a bisphosphonate medication such as alendronate (Fosamax) 70mg once weekly, as supported by the most recent evidence from 1 and 1.
Treatment Approach
The treatment approach should include:
- Bisphosphonate medication, such as alendronate (Fosamax) 70mg once weekly, taken first thing in the morning with a full glass of water, remaining upright for 30 minutes afterward 1
- Calcium supplementation (1000-1200mg daily) and vitamin D (800-1000 IU daily) to support bone health 1
- Weight-bearing exercise like walking or light resistance training for 30 minutes most days to improve bone density and reduce fracture risk 1
Rationale
The World Health Organization (WHO) criteria define osteoporosis as a T-score value less than or equal to -2.5 at the lumbar spine, one-third (33%) radius, femoral neck, or total hip, as stated in 1. Although the T-score of -2.90 is slightly above this threshold, the most recent evidence from 1 suggests that the same T-score threshold and female NHANES reference range can be used for both men and women.
Considerations
Alternative medications like denosumab (Prolia) or teriparatide (Forteo) might be considered if bisphosphonates are contraindicated or not tolerated, as mentioned in 1. The treatment duration is typically 3-5 years initially, with periodic reassessment of bone density, as recommended in 1. Side effects may include gastrointestinal irritation, which is why proper administration is important, as noted in 1.
Fracture Risk Assessment
The FRAX (World Health Organization Fracture Risk Assessment Tool) can be used to predict fracture risk among people with low bone density, as mentioned in 1 and 1. This tool takes into account clinical risk factors, such as prior fragility fracture, parental history of hip fracture, and current tobacco smoking, to estimate the 10-year probability of a major fracture or hip fracture.
Monitoring and Follow-up
Regular monitoring of bone density and fracture risk is essential to adjust treatment as needed, as recommended in 1 and 1. This may involve periodic DXA scans and reassessment of FRAX scores to ensure that the treatment is effective in reducing fracture risk.
From the Research
T Score Interpretation
- A T score of -2.90 indicates osteoporosis, as it is below the threshold of -2.5 2, 3, 4, 5
- Osteoporosis is a condition characterized by low bone mass and density, leading to an increased risk of fractures
Treatment Options
- Bisphosphonates, such as alendronate and risedronate, are commonly used to treat osteoporosis and can help increase bone mass and reduce the risk of fractures 2, 3, 4, 5
- Other treatment options, such as denosumab, may also be effective in increasing bone mineral density and reducing bone turnover markers 5
Bone Mineral Density (BMD) Changes
- Studies have shown that bisphosphonates can increase BMD at various sites, including the lumbar spine, total hip, and forearm 4, 5
- Denosumab has also been shown to increase BMD and reduce bone turnover markers compared to risedronate 5
Note
- The provided study 6 is not relevant to the topic of osteoporosis and T scores, as it discusses mild traumatic brain injury symptoms and long-term outcomes.