Osteoporosis Treatment

Cut through the fog about
osteoporosis treatment:
understanding your options


Of all the womens health issues I see in my office, osteoporosis treatment is one of the most challenging to address. Knowing that such a complex topic really requires a face to face office appointment to customize a treatment plan for you, I will take a few moments on this page to summarize some of the issues important to consider, including hormone replacement therapy, bisphosphonates, and exercise for osteoporosis.

What’s your risk of a fracture?

The first very important issue to clarify before beginning any osteoporosis treatment is the actual predicted risk of a fracture. There are a couple of ways to consider this. One way to begin is to recognize that the average age of hip fracture for American women is 81 years of age. So while significant bone density is lost in a large percentage of women by the age of 50, most of those women will not experience a fracture for at least 30 years. And many of the drug studies used to support the prescription of bisphosphonates and other drugs enroll younger women, so while they may improve bone density, they are not able to show an actual reduction in number of fractures. You can find ways to calculate your risk of an osteoporotic fracture if you know your Z-score or T-score (from your DEXA bone density test) and your age; search online for the WHOFracture Risk Assessment Tool or a similar fracture risk calculator. At the end of that calculation, if you know your risk of a hip fracture in the next 10 years is only 2%, it puts the relative risk and benefit of long term medication in perspective.

Gambling on no fracture… what are your odds?

Another way to evaluate the relative risks and benefits of osteoporosis treatment is to understand a decision tool called “number needed to treat.” The “number needed to treat” is the number of patients who have to take a medicine in order to prevent just One of them from having a bad outcome. This will be a little more work for you, as your doctor may not have done this simple calculation either. But here’s how it works. If you were to read the fine print that comes with a prescription of a bisphosphonate or other prescription (you can find these online, or ask a pharmacist), you will find that they show you tables of data that justify the use of that medication. In the case of osteoporosis medications, the data tables will show an important number called “absolute risk reduction.” (it’s important to use this number instead of the “relative risk reduction” for this calculation). So if a bisphosphonate shows an absolute risk reduction of 5% (0.05) in hip fractures over a 3 year study, you calculate the number needed to treat as 1.0 divided by the absolute risk reduction (in this case 5% or 0.05), so the number is 20. That means 20 women would have to take that medicine for 3 years to prevent one of them from having a fracture. The “number needed to treat” is 20. This is a little like gambling, as you don’t know if you would be the one with the fracture or a part of the healthy majority, but if the odds are in your favor you can think more clearly about the risks and benefits of prescriptions.

With that background and perspective, I think you will be able to make a much more informed and empowered decision when faced with a choice about osteoporosis medication.

For your health and wellness,



Robert Pendergrast, M.D. 

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