When to start osteoporosis treatment
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
