Beatrice Edwards, MD: The Best Way to Treat Osteoporosis

so osteoporosis in terms of fracture

protection medications are absolutely

necessary calcium and vitamin D are the

mainstay of therapy and that is what the

placebo arm has used in many of the

clinical trials but even in the clinical

trials you see the number of fractures

so you need the anti resort of agent to

reduce the fracture risk as you look at

the older population however Falls

become an issue and so 30% of women fall

in a given year of women over the age of

65 so you have to have an intervention

which is non pharmacologic which is

either physical therapy or Tai Chi

checking a vitamin D status making sure

that their vitamin D replete as ways of

reducing fall risk in addition in some

of the more senior you're going to do a

home safety evaluation to make sure they

don't have environmental hazards like

low level lighting cluttered hallways

throw rugs things that can cause Falls

that their stairways I will lid so it's

a number of interventions you're going

to implement in order to reduce Falls

and fractures

one of the biggest challenges is

misinformation much of the information

that has gone to the media that has been

aired in all the channels and all the

newspapers has been the fear of Antibes

orbs of Asians the fear of Austin

necrosis of the jaw and that is a

significant barrier when you speak to

women particularly women more than men

in terms of the fear that the agents are

going to cause side effects and for them

the risk is almost commensurate with a

benefit no one has really sat down and

looked at the numbers with them and when

we work with the American Society of

Bone and Mineral Research on a paper on

long-term safety of anti resorbed of

agents of bisphosphonates we looked at

the risk of suffering a fracture which

in a lifetime is 50% that's about the

risk and then the risk of a hip that's a

vertebral fracture and then a hip

fractures about 15% we compared that to

the risk of suffering a car accident

which is like 1 in 10,000 and then the

risk of suffering austria necrosis of

the jaw which is like 1 in 60,000 so

very small bar there and then we looked

at atypical femur fractures and the risk

of that was similar to the risk of being

murdered so we don't walk around

thinking that we're going to be murdered

and so that's what I explained to

patients as I would show them the bar

chart they would say no one has ever

explained that to me so I feel but that

is a significant issue because if you

explain even to older patients you know

the medicine will work very quickly and

will be very effective reducing

fractures they understand that the

another issue that they raised is if the

insurance is going to cover it and then

the number of medications they take and

for the second one I mean having the

medications that you can administer

every six months or once a year are

really optimal for them because they

already have a number of pills that

they're taking that you don't want to

add to their burden so I think those are

the the biggest of the fear the coverage

and then polypharmacy are the biggest

barriers that they encounter they're not

afraid of being screened

they're not afraid of being asked what

they consume in their diet

they're they're okay with that and I

think when you really tell them you know

we can preserve your quality of life you

can preserve your independence they

really get it