Management strategies for osteoporosis and osteopenia

A 60-year-old woman came into our office for her annual examination. We noted that she had lost 1.5 inches in height. We secured an immediate appointment with the dual-energy x-ray absorptiometry (DXA) technician. The result was a T-score of –1.5 (low bone mass, osteopenia). The questions were: How to treat her condition? Was a prescription therapy needed? Which therapy (eg, bisphosphonate, selective estrogen-receptor modular [SERM], or parathyroid hormone [PTH]) was most appropriate? How should she be treated in light of the many complications from long-term therapy?

Eventually, our dilemma would be how to treat this woman without overtreating her. To make an appropriate decision about whether and how to treat her, associated information must be gathered, including history and laboratory results. Evaluation guidelines are followed by discussion of 3 different scenarios.

History

Laboratory workup

These tests should be ordered: