Postmenopausal Osteopenia and Osteoprosis: Treatment

By: Maged Taman

All patients: Elemental calcium 1200 mg + Vitamin D 800 units daily. Stopping smoking, decrease alcohol, exercise and fall prevention. Check 25 vitamin D and correct as indicated.

Drug therapy according to patients groups: the lowest BMD (Bone Mineral Density)on either the hip or the lumbar spine will determine treatment.

1- Osteopenia BMD -1 to -2.5 with low risk of fracture no drug therapy.

2- Osteopenia patients with low BMD (T-score between -1.0 and -2.5 at the femoral neck or lumbar spine) if there is an estimated 10-year probability of hip fracture of ≥3 percent or of major osteoporotic fracture ≥20 percent. alendronate (5 mg/day or 35 mg/week), risedronate (5 mg/day, 35 mg/week, 150 mg/month, or 75 mg on two consecutive days once monthly), and ibandronate (150 mg/month).

3- Osteoporosis BMD lower than -2.5 alendronate (10 mg/day or 70 mg/week), risedronate (5 mg/day, 35 mg/week, 150 mg/month, or 75 mg on two consecutive days once monthly), and ibandronate (150 mg/month). Ibandronate did not prove yet that it can prevent hip fractures. Zoledronic acid is Likely to be the drug of choice given once a year as infusion 5 mg over 1/2 hour followed by Tylenol for few days for possible flu like symptoms.

4- Osteoporosis BMD lower than -2.5 and no fragility fractures but unable to tolerate biophosphante, raloxifene 60 mg po daily will be a good choice, only for postmenopausal.

5- Osteoporosis with BMD lower than -2.5 and fragility fracture who unable to tolerate biosphosphante or fracture after one year on biophosphanate Teriparatide 20 mg SC daily is given for two years only.

Monitoring for BMD in two years, if stable less frequent monitoring. Rate of decline of BMD with no treatment is 0.5 to 1.0 percent in one year if no anti-osteoporosis medication used.