An osteoporosis diagnosis might come as a surprise, but it may also be the first step toward taking control of your bone health.
Your treatment options and the way you talk with your medical team are key to protecting your health and your rights as a patient.
“At first, I didn’t understand how the medications worked or how they differed, but now I’m familiar with them. I ask important questions to my endocrinologist and gynecologist,” says Miami resident Amy Shelman, who was diagnosed with osteoporosis in 2021 at age 61.
Menopause accelerates bone loss, and doctors, including gynecologists and endocrinologists, are trained to identify this risk.
Understanding Your Diagnosis Is Vital
The first step after your diagnosis is to understand your condition and how your doctors assess your bone health. This way, they can choose the most appropriate treatment.
What is osteoporosis?
Osteoporosis is a disease that weakens the bones. It causes them to become thinner (outer layer) and less dense (inner structure). If you have osteoporosis, you are more prone to fractures, but there is a lot you can do to reduce that risk.
But not all osteoporosis diagnoses mean the same. The disease can progress in different ways, and treatment will depend on your personal health story and the condition of your bones.
“It’s important to understand how severe your osteoporosis is compared to other cases, what the expected course of the disease is, and what your long-term medication plan is,” Shelman says.
How is osteoporosis evaluated?
To find out how strong your bones are and confirm whether you have osteoporosis, your doctor may perform a bone density scan (DXA). It is a noninvasive X-ray that takes 10 to 20 minutes and measures the mineral density (hardness) of your bones.
This test gives you a result known as a T-score. This number compares your bone density with that of a young person of the same sex without osteoporosis, so the result is always a negative number.
Depending on the T-score, different medical treatments are recommended.
T-score results
Osteoporosis is classified according to your bone density T-score:
- If your T-score is within 1 point of the young adult average, you have normal bone density.
- If your T-score is between 1 and 2.5 points below that average, you have low bone mass.
- If your T-score is 2.5 below that average, you have osteoporosis.
Be Proactive and Know Your Rights
Taking the initiative and asking specific questions during your appointments is crucial, especially when it comes to understanding and managing medications. Medications vary depending on the degree of your osteoporosis.
“I was prescribed bisphosphonates without understanding how they worked. I didn’t feel comfortable taking them, so I sought the opinion of an endocrinologist, who decided it wasn’t yet necessary,” says Shelman.
Shelman paused treatment, but her next DXA showed worsening bone density. She decided to resume treatment.
Your rights
As a patient, you have the right to ask questions and receive clear and ethical answers, as well as to be involved in the decision about the medications prescribed for you.
According to the American Medical Association’s Code of Ethics, you have the right to:
- Receive treatment with courtesy, respect, and dignity, as well as timely and sensitive care tailored to your needs.
- Receive information from your doctors and the opportunity to discuss the benefits and risks of treatments.
- Ask questions about your health status and how you are responding to treatments.
- Make decisions about recommended medical care and have those decisions respected.
- Ask for a second opinion.
What to Ask Your Doctor
Based on her experience, Shelman recommends bringing this list of questions to your doctor’s appointments if you’ve just been diagnosed with osteoporosis:
- What can I expect from my DXA test?
- What does my T-score result mean?
- What medications are available for my degree of osteoporosis?
- What are the side effects of these medications?
- What types of exercises are recommended for me?
- Are there things that I should avoid?
Your Support Network
If you’ve been diagnosed with osteoporosis, the support of your family, friends, or loved ones is key. They can accompany you to your medical appointments and help you avoid movements or loads that increase your risk of fractures.
There are steps you can take to manage osteoporosis, especially during the fall and winter months.
In addition, your support network can:
- Keep your home safe and free of tripping hazards.
- Remove leaves, ice, or snow from your driveway.
- Join you on walks or during exercise.
- Go with you to medical appointments and take notes.
- Encourage a balanced family diet rich in calcium, protein, and vitamin D.
Understanding Medication Options
There are two common types of medications that help treat osteoporosis. Bisphosphonates and anabolic agents. There are also hormonal treatments as well as newer medications if your bone loss is severe or you are not responding to other treatments.
Bisphosphonates. They are often the first choice for treating osteoporosis. These include:
- Alendronate (Binosto, Fosamax): One pill daily or weekly
- Ibandronate: A monthly pill or an intravenous (IV) infusion every three months
- Risedronate (Actonel, Atelvia): One pill daily, weekly, or monthly
- Zoledronic acid (Reclast): One annual IV infusion
Another common medicine for osteoporosis is denosumab (Prolia). It’s not a bisphosphonate, but it may be an option if you can’t take bisphosphonates, don’t tolerate them well, or have kidney problems.
Anabolic agents or medications for osteoporosis. Drugs that help your body build new bone. These include:
- Abaloparatide (Tymlos): A daily injection, usually in your abdomen
- Romosozumab (Evenity): Two injections once a month from your doctor
- Teriparatide (Forteo, Bonsity): A daily injection in your thigh or abdomen
Anabolic drugs are usually reserved for people with very low bone density, who have already had fractures, or whose osteoporosis is caused by steroid use.
Hormonal therapy
Hormone replacement therapy (HRT), which can be estrogen-only or estrogen and progestin, helps keep your bones strong and reduces the risk of fractures.
A medication called Duavee (estrogen and bazedoxifene) is approved to treat menopausal hot flashes and can also prevent osteoporosis in women who have already gone through menopause and have kept their uterus. Duavee should not be given to women who do not have a uterus.
In addition, Duavee may increase the risk of some health problems, such as gallbladder diseases, certain types of cancer, and dementia. It may also increase the risk of blood clots, stroke, or heart attack, even after stopping it.
Your doctor will evaluate whether the benefits of taking Duavee outweigh its risks to your health.
Selective estrogen receptor modulators (SERMs)
Raloxifene (Evista) is another medicine for osteoporosis. It is used in postmenopausal women to slow bone loss. It does not increase the risk of breast or uterine cancer, but it can cause blood clots and more hot flashes.
Women Are at Greater Risk
White and Asian women over 50 are at higher risk of developing osteoporosis. Hispanic women have also been shown to have about the same risk as white women. But compared with men, women of all racial and ethnic groups are more likely to experience bone loss.
The importance of reporting symptoms
Blanca Stella Gil, a 65-year-old Colombian resident of Miami, was diagnosed with osteoporosis a few months ago. Her diagnosis wasn’t due to a fracture but because she mentioned a symptom to her doctor.
“During a routine exam, I told my doctor I had pain in my lower back,” she says. Now, with her doctor’s guidance and the correct information, Gil follows an exercise and medication plan.
“I stretch every day, and the doctor gave me an injection that lasts for a year. I take vitamins, do yoga, and eat well,” says Gil.
Osteoporosis Resources and Support
Several sources of information and support are available to you:
Bone Health and Osteoporosis Foundation (BHOF): provides useful data, support groups, and an online community.
National Institutes of Health (NIH): provides comprehensive information on osteoporosis and related conditions.
Social media communities: Facebook and other platforms have groups where you can share experiences and receive moral support.
Amy Shelman advises you to take preventive measures if you have a family history of osteoporosis: “Be consistent with calcium, avoid smoking, and perform weight-bearing exercises,” she says.
Show Sources
Photo Credit: FatCamera/Getty Images
SOURCES:
Roselyn Bonilla, MD, board-certified gynecologist, MASF Docs, Miami Springs, Florida.
Amy Shelman, patient with osteoporosis, Miami.
Blanca Stella Gil, patient with osteoporosis, Miami.
USSan Diego Health: “Bone Density Test (DEXA or DEX).”
American Medical Association: “Code of Medical Ethics.”
Bone Health and Osteoporosis Foundation.
Cleveland Clinic: “Osteoporosis.”
