"Do I Meet The Criteria For Osteoporosis Drugs?"


Osteoporosis drugs are not substitutes for proper nutrition. Consider osteoporosis drugs in addition to supplements if you meet these 3 criteria. Most physicians now recommend that patients taking osteoporosis medicines also maintain a bone health program that includes supplements, diet and exercise.

Deciding to take prescription osteoporosis medicines is a big decision. The criteria for taking osteoporosis drugs is controversial, even among physicians, and there are many exceptions. However, there are an alarming number of cases where prescription osteoporosis drugs are recommended for patients who just have low bone density or osteopenia.

Men and women who have broken a bone and have low bone density are the most likely to benefit from prescription medicines for osteoporosis. A broken bone puts them at the highest risk for additional fractures - and helping to prevent additional fractures is the selling point of most osteoporosis drugs.

According to guidelines proposed by the National Osteoporosis Foundation, osteoporosis medicines should be considered for postmenopausal women and men over the age of 50 if they have one or more of the following:

1. Hip or vertebral fracture.  Any fracture between the ages of 20-50 increases the risk of another, but hip and vertebral fractures are particularly serious.  After a hip fracture, the opposite hip loses bone at a fast rate because the fracture healing process actually steals proteins and minerals from other parts of the skeleton to heal. There is significant evidence that patients with spine and hip fractures will have reduced fracture risk if treated with osteoporosis medicines. This is true for patients with both osteopenia and osteoporosis. In this case, the fracture is a better indicator than a T-score at predicting the risk of future fractures.

2. Bone Density T-score of -2.5 or less at the femoral neck, total hip or lumbar spine. The T-score on your bone density report shows how much your bone mass varies or deviates from the bone mass of an average healthy 30 year old. A T-score of -2.5 or below at the femoral neck, total hip or lumbar spine may require osteoporosis drugs. The femoral neck is part of your hip joint. It’s called a “neck” because it is rather graceful and tapered like a neck. It has nothing to do with your spine – but is easy to confuse because of the name. The density in the femoral neck is important because typically it is the most vulnerable area to fracture.

However, many women who meet the bone density t-score criteria are reluctant to start osteoporosis medicines if they’ve never had a fracture. Studies of two of the most popular bisphosphonates, Actonel® and Fosamax®, show insignificant difference in fracture prevention in women compared to those who take nutritional supplements.

Sometimes the results of drug treatment sound better than they really are. Success rates are often inflated and its not uncommon for a weak statistic like 1% to be manipulated. Look for the “true rate” of fracture reduction instead of the percentage. The benefits of bisphosphonates may be limited for women who have low bone density but have never had a fracture.

3. Bone Density T-score between -1.0 and -2.5 at the femoral neck or lumbar spine and a 10-year probability of a hip fracture greater than 3% or a 10-year probability of a major osteoporosis-related fracture of more than 20%.  While all three criteria are important (and technical), fracture risk depends on other lifestyle habits and your family history of fractures.  Additionally, a bone density test is just one option for measurement. Risk of fracture can also be calculated using a simple test that anyone can take, called FRAX.  You can access the FRAX tool here (bottom of page). The same concerns about starting osteoporosis drug treatment apply to this group if you’ve never had a fracture.

Supplements further decrease the risk of fractures, even for people taking osteoporosis medicines.  In fact, physicians are increasingly encouraging patients to maintain a bone health program of supplements, exercise and diet while taking osteoporosis medicines.  We know that women who take Fosamax® and other bisphosphonates almost always require supplementing with additional vitamin D – and other nutrients like silicon increase the benefits of vitamin D and calcium. Physicians are less likely to be aware that deficiencies of magnesium, silicon, Vitamin K2, and boron are also widely prevalent and these nutrients are so important for bone health.  You’re never too young or too old to add a nutritional supplement that supports your bones. And don’t forget that supplements can also improve balance. This decreases the risk of falls with measurable differences in your bone health as fast as six weeks after adding to your diet.

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