Osteoporosis Treatment Guidelines for a 70-Year-Old Female

Diagnostic Confirmation and Risk Assessment

The American Academy of Family Physicians recommends confirming the diagnosis with a DEXA scan showing T-score ≤ -2.5 to establish osteoporosis diagnosis 2, 1
For patients with a T-score between -1.0 and -2.5, the American Academy of Family Physicians suggests using FRAX to calculate 10-year fracture risk 2, 3
Treatment should be considered if FRAX shows ≥20% risk of major osteoporotic fracture OR ≥3% risk of hip fracture, as recommended by the American Academy of Family Physicians 2, 3
The American Academy of Family Physicians also recommends considering treatment even without osteoporosis on DEXA if the patient has a history of low-trauma fracture 2

The American Geriatrics Society recommends bisphosphonates as the preferred initial therapy, based on high-quality evidence showing they reduce hip fractures by 50% and vertebral fractures by 47-56% over 3 years 4, 5, 1
Alendronate 70 mg once weekly is a common choice for oral bisphosphonates, as recommended by the American Academy of Family Physicians 2, 1
Risedronate 35 mg once weekly is an alternative option, according to the American Academy of Family Physicians 2

The American Academy of Family Physicians recommends calcium 1,200 mg daily and vitamin D 800 IU daily for all patients 2, 1
The target serum vitamin D level should be ≥20 ng/mL, as recommended by the American Academy of Family Physicians 2

The American Academy of Family Physicians suggests weight-bearing exercise, such as walking or dancing, for all patients 2, 1
Smoking cessation is also recommended by the American Academy of Family Physicians to reduce fracture risk 2, 1
Limiting alcohol intake is advised by the American Academy of Family Physicians to prevent falls and fractures 2, 1

The initial treatment duration should be 5 years, as recommended by the American College of Physicians 1
Bone density should not be monitored during the initial 5-year period, according to the American College of Physicians 1
After 5 years, fracture risk should be reassessed to determine if continuation is warranted, as recommended by the American College of Physicians 1, 3

Bisphosphonates can cause short-term upper GI symptoms and influenza-like symptoms, as well as long-term atypical femoral fractures and osteonecrosis of the jaw, according to the American Geriatrics Society 3
Denosumab can cause mild GI symptoms, increased infection risk, and rash/eczema, as reported by the American College of Physicians 1

The American Geriatrics Society recommends not skipping calcium and vitamin D supplementation, as pharmacologic therapy is less effective without adequate supplementation 4, 5
Ensuring proper bisphosphonate administration technique is crucial to minimize GI adverse effects and maximize absorption, as advised by the American Academy of Family Physicians 2
The American College of Physicians warns against abruptly discontinuing denosumab without transitioning to a bisphosphonate to prevent rebound fractures 1