At what T-score should bisphosphonate therapy be started in a patient with low bone mass? At what T-score and patient age does the benefit of bisphosphonate therapy outweigh the risk?—MAURISA KONYA, PA-C, Phoenix
I have been taking risedronate (Actonel) for the past year to help restore bone density. What long-term effects will this medication have on my body? Will I have to take it for the rest of my life?—SUE COLEMAN, LPN, Lynchburg, Va.
Osteoporosis, particularly postmenopausal, has traditionally been indicated by an axial bone densitometry score >-1.5. Confusion about what to do for patients who were lower than normal but not yet at -1.5 was common. Thanks to research and electronic media, providers are now able to use other resources to determine when a bisphoshonate is appropriate. Instead of relying solely on the T-score, use the FRAX risk assessment tool, which takes other pertinent information into account.
Recent reports of femoral neck fractures in women who have been taking a bisphosphonate for many years spurred new studies that confirmed the possibility of bones becoming brittle after years of bisphosphonate use. Consequently, research indicates that the maximal benefit from these drugs occurs in the first five to 10 years and that cessation of the drugs after that point can be considered.
As far as risks and benefits, I explain to my patients that I put their situation on a virtual balance scale. To the best of our ability, we then place what we know of the risks of therapy on one side of the scale and the patient’s risk factors for fracture and other long-term sequelae on the other. If we agree that the risks of not treating outweigh the potential risks of therapy, therapy is initiated. For further discussion, see Mayo Clin Proc. 2008;83:1032-1045 (available at www.mayoclinicproceedings.com/content/83/9/1032.long, accessed January 15, 2011) and Age Ageing. 2009;38:625-626 (available at ageing.oxfordjournals.org/content/38/5/625.long, accessed January 15, 2011).—Sherril Sego, FNP-C, DNP (148-13)