Strategies of Osteoporosis Treatment

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Osteoporosis cannot be cured but it can usually be managed.  This medical intervention can forestall advancement of the disease.  How long?  Indefinitely, it appears.  Modern drugs are now enough that we don’t have long-term data for enough people to say for sure.

How is a management strategy formed?  The doctor takes into account the ways and means to address the osteoporosis given the particulars of the patient, the types of treatment available, and the environment.  The situational factors to be considered include: 

Financial

• Availability of drugs
• Cost of drugs
• Patent status of drugs
• Patient’s insurance coverage

 Treatment history

• Side effects in previous treatment
• Efficacy of previous treatment
• Length and type of previous treatment

Bone Health

• Z-score as found on DEXA scan
• Other diagnostic test results (if any)
• History of broken bones
• Calcium level in blood
• Other bone diseases

General health and Lifestyle

• Kidney functions
• Weight / obesity
• Level of activity / lifestyle
• Other diseases and illnesses

Patient make-up

• Likelihood of patient complying with regimens
• Access to refrigerator/willingness to inject self (if teriparatide is being considered)
• Other drugs the patient takes
• Willingness/tendency to come in for follow-up treatment and evaluation

Individual doctors taking care of individual patients formulate the strategy, but they are typically guided and influenced by the profession as a whole, including reports from other doctors and the federal government.  The best strategy is proactive.  It is based on the best available evidence and takes into account possibilities and probabilities.  The focus is on resources and means.

Ideally, the patient comes back in for regular check-up and bone density scans and the doctor can modify the regimen if needed.  Good strategies are adaptable and flexible and take into account changes in the various factors as well as whether the treatments are working.

Goal Directed Treatment

Scientists at the University of California, San Francisco have proposed a shift in the treatment paradigm toward goal-direction as a more "rational and effective" method of employing available treatment options. They point to hypertension as a condition in which preventative medicine is used to control blood pressure where the doctor and patient look at actual blood pressure after treatment. Rather than modifying treatment regimens after a certain period of time or lack of change in bone density, the goal-directed plan would include regular assessment of density and setting a goal of either risk of fracture (to the extent this can be assessed) or BMD.