A 68-year-old Caucasian woman comes to your office for advice regarding her risk factors for developing osteoporosis. She is 5 ft 1 in tall and weighs 105 lb. She stopped having periods at the age of 42 years. She is healthy and walks on a treadmill daily. She does not take any medications. She has never taken hormone replacement therapy (HRT). Her mother died at the age of 71 after she suffered a spontaneous hip fracture.
The patient has a DEXA study that demonstrates a T-score of –2.0.
What is the best next step in management?
A. Begin a bisphosphonateOsteopenia is defined as a T-score between –1 and –2.5 standard deviations from the mean (SD). Osteoporosis is defined as a T-score below –2.5 SD. A T-score is the standard deviation between the patient and the peak young adult bone mass. The more negative, the greater the risk of fracture. This patient has osteopenia based on her DEXA, and she also has risk factors for fracture (low body weight, family history, of fracture), making her a good candidate for pharmacologic therapy to reduce her risk of fracture. Bisphosphonates are considered first line therapy as they are well tolerated, relatively low cost, and have a favorable safety profile. Raloxifene, a selective estrogen receptor modulator (SERM), is effective at reducing the risk of vertebral fractures, but is associated with an increased risk of thromboembolism; therefore, it is usually used in situations where bisphosphonates are not well tolerated. HRT is not indicated for the management of osteoporosis or osteopenia.