As we age our bone density decreases. In a moderate degree, this is called osteopenia.Osteoporosis is a more severe level of bone loss. This is classically measured by a bone density study (DEXA). A “T score” of -2.5 indicates osteoporosis. Osteopenia and osteoporosis can be treated in several ways: Weight-bearing exercise, especially walking, is helpful. Adequate vitamin D (approximately 800 – 1000 units daily) and calcium (1000 – 1500mg daily) is important. There are medicines that may be prescribed to improve bone density and strength to decrease one’s risk of having a fracture (broken bone). The decision to treat low bone mass is based on the risk fracture. The World Health Organization (WHO) has a website which calculates this risk based on one’s personal history, family history, and DEXA score.
When to Consider Treatment with an Osteoporosis Medicine—In Postmenopausal Women and Men Age 50 and Older
Most people with T-scores of -1 or higher do not need to consider taking a medicine.
-1 and higher
+1.0 +0.5 0 -0.5 -1.0
Low Bone Density (Osteopenia)
People with T-scores between -1.0 and -2.5 should consider taking a medicine when there are certain risk factors suggesting an increased chance of breaking a bone in the next 10 years.
-1.1 to -2.4**
-1.1 -1.5 -2.0 -2.4
FRAX score less than 3% at the hip or less than 20% at other sites may not need medicine
FRAX score 3% or higher at the hip or 20% or higher at other sites may need to consider medicine.
All people with osteoporosis should consider taking a medicine.
-2.5 and lower
-2.5 -3.0 -3.5 -4.0
There are several families of medications used to improve bone strength. Each has different mechanisms of action, benefits and downside risks. It is important to remember that, although there are risks for treatment there are also very real risks in failure to treat which include, not only the pain and disability of fractures, but also significant potential for permanent loss of function and inability to continue an active, independent lifestyle. Below is a table regarding different medication options from the National Osteoporosis Foundation: www.nof.org
Medicines Approved to Prevent and/or Treat Osteoporosis
Class and Drug
Generic Alendronate and Fosamax®
Fosamax Plus D™ (with 2,800 IU or 5,600 IU of Vitamin D3)
Intravenous (IV) injection
Four Times per Year
Actonel® with Calcium
Intravenous (IV) infusion
One Time per Year/Once every two years
Transdermal (skin patch)
Estrogen Agonists/Antagonists Also called Selective Estrogen Receptor Modulators (SERMs)
RANK ligand (RANKL) inhibitor
Every 6 Months
Please talk to your SOSMed physician or your primary care provider to learn more.