Emily M. Stein, MD
Emily M. Stein, MD, endocrinologist and associate research scientist, Hospital for Special Surgery, and assistant professor of medicine, Weill Cornell Medical College, both in New York City.
I’m 62 years old and have never had a bone fracture, yet my doctor has prescribed Fosamax because I have osteopenia. Do I really need it?
That depends. A diagnosis of osteopenia means your bone density is low but not as low as the more severe diagnosis of osteoporosis. While low bone density is one reason to recommend medications that preserve bone, it is critical to ask your physician why the treatment is recommended. There may be other factors in your medical history that are placing you at high risk for osteoporosis. While a prior fracture that occurred without major trauma is the most significant, other factors–taking glucocorticoids (Prednisone) for a long time, for example–affect bone quality without making bone density particularly low. Therefore, when deciding whether to begin treatment, it is important to take all risk factors into account, not just the bone density test. Osteoporosis medications, such as alendronate (Fosamax), are typically very effective and can reduce the risk for fracture by half. However, the medications can cause side effects, such as severe heartburn, ulcers, muscle aches and difficulty swallowing. For patients who are at low fracture risk, medication is typically not prescribed because the risk for a side effect outweighs the risk for fracture. For patients at high risk for fracture, treatment is recommended because the consequences of a serious osteoporotic fracture can be very serious. For example, major osteoporotic fractures can greatly interfere with quality of life, and the ability to care for yourself and live alone. In the first year following a hip fracture, 25% of people will die from complications. Many more people are unable to walk or get about unassisted after a major fracture. Talk to your doctor about other things that you may do to improve your bone health, such as engaging in weight-bearing exercise, consuming adequate amounts of calcium and vitamin D and quitting smoking. These are helpful things for everyone to do. However, it is important to realize that for patients who are at high risk, these can be helpful in addition to medication but are not sufficient on their own. You might also consider a consultation with a metabolic bone specialist to understand your fracture risk and to clarify the specific risks and benefits of treatment. A metabolic bone specialist is typically an endocrinologist or rheumatologist who has specific expertise taking care of patients with osteoporosis or other bone problems. You can ask your primary care doctor or gynecologist for a recommendation or look for a metabolic bone center affiliated with a major medical center in your area.
