Osteoporosis: Managing Treatment

Consider this scenario. You’ve ruled out secondary causes for osteoporosis, initiated bisphosphonate treatment, and repeated the patient’s DEXA scan after one year. However, the score is going down. Now, what do you do? Change the patient’s treatment plan (eg, anabolic therapy) or maintain current therapy?

The above scenario sets the stage for Part 2 of Osteoporosis: Treatment Controversies. Our panel provides some guidance.
  • Re-screen for a secondary cause of bone loss
  • Repeat comprehensive blood tests and 24-hour urine measurement for calcium excretion
  • Check medication compliance (eg, bone turnover markers)
  • It is not uncommon to find celiac disease or a malabsorption disorder.

Some primary care physicians may feel uneasy about continuing to treat their patients with osteoporosis. The PCP may question, “Should I refer this patient to an endocrinologist?” While you may be comfortable prescribing the medications, if the second DEXA shows no improvement, Leonard Egede, MD suggests making the referral to a specialist, such as an endocrinologist.

Other topics discussed during this video segment, include:
  • Should anabolic and anti-resorptive therapies be combined?
  • Is it rare in a patient to be nonresponsive to either prescribed therapy?
  • How do you differentiate between a moderate and high-risk patient?
  • Should you commence a “drug holiday” after five or 10 years?
  • Typically, how long should a “drug holiday” last?
  • Dr. Egede explains the importance of using a risk versus benefits approach to increase patient compliance with the prescribed therapy(ies)


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Osteoporosis: Screening and Assessment
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