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Balancing the Benefits and Risks of Osteoporosis Treatment
Michael Lewiecki, MD, FACP, FACE posted:
If you have osteoporosis and are trying to make a decision about treatment, you should compare the risk of having a fracture (broken bone) if you do not take medication with the expected benefit of treatment (reduction of fracture risk) and the potential risks of treatment (side effects). When the benefit of treatment outweighs the risk, then you should consider taking the medication. Other factors to think about are your past experience with osteoporosis medication, other medical problems, the cost of treatment, and your personal level of concern about breaking bones or having side effects of treatment.

What is your risk of breaking a bone?

A bone density test is often the first step in evaluating fracture risk. When the T-score is -2.5 or below in a postmenopausal woman or man age 50 or older, then a diagnosis of osteoporosis is made. Your healthcare provider can help explain to you what your T-score means. Additional information about fracture is provided by "clinical risk factors" for fracture, such as age, previous fracture, cigarette smoking, and family history of osteoporosis. Even with the same T-score, an older person has a higher risk of fracture than a younger person, and someone with a previous fracture as an adult has a higher risk of fracture than someone who has never had a fracture. If you have never taken an osteoporosis medication, a computer program called FRAX® can estimate your chance of breaking a bone in the next 10 years.

What are the benefits of taking a medication?

Learn about all of the treatment options available to you. All approved osteoporosis medications have been proven in research studies to reduce fracture risk. It is not known with certainty whether any medication reduces fracture risk more than another, since these medications have not been testing in that way side-by-side. There may be differences in insurance coverage and out-of-pocket expenses. Your healthcare provider can help you to decide which choices are best for you based on your medical history and other factors unique to you.

What are the possible risks of taking a medication?

When making a decision about treatment, you should learn about the possible side effects of each medication. When something is listed as a side effect, it does not necessarily mean it will happen to you. For example, a rash may be listed as a side effect of a drug with a risk of 1%. That means that 1 out of 100 patients have had a rash while taking the drug and the other 99 did not have a rash. It does not mean that you will get a rash 1 of 100 times that you take the drug. Your risk of having certain side effects may depend on other health problems you already have. Talk to your healthcare provider or pharmacist about your potential risk of side effects.

Making to decision to treat and how to treat

The best decisions are made as a team, with your healthcare provider giving you all the necessary information you need to understand benefits and risks, and you telling the healthcare provider about your concerns. Once treatment is started, tell your healthcare provider if you are having problems or you are worried about having problems with the medicine. Don't allow your medical care to be directed by what you hear in the news or read in magazines and newspapers. These sources often do not provide accurate information. Talk to your healthcare provider before stopping your medicine or making any changes in treatment. Good teamwork is the best way to stay healthy.

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For more information, visit the National Osteoporosis Foundation website