Decision to treat osteoporosis with pharmaceuticals

If bone density is low at 1 or more skeletal sites and it meets the world health organization (WHO) criteria for “low bone mass” (T-score between -1.0 and -2.5) the threshold where pharmacologic therapy is recommended by the National Osteoporosis Foundation (NOF) treatment should be contemplated. However all treatment decisions require clinical judgement and consideration of individual factors namely:

  • Patient Preferences
  • Comorbidities
  • Previous drug use
  • Risk Factors not captured in the FRAX model:
    • Frailty
    • Falls
    • Vitamin D deficiency
    • Increased bone turnover
    • Interval significant decline in bone density
  • Possible under/over estimation of fracture risk by FRAX

Patients should follow a healthful lifestyle regardless of type of Pharmacological intervention:

  • Good Nutrition with adequate calcium and Vitamin D
  • Appropriate weight-bearing exercise

Follow Up DEXA Measurements

If a patient is treated with pharmaceuticals consider repeating the DEXA study in 1 year to reassess the patients status/response on treatment.

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