Osteoporosis: Treatment Controversies

The panel’s discussion involves, “what are the next steps” when your patient is diagnosed with osteoporosis. Where do you start?

Pauline Camacho, MD explains, “When you have a patient with osteoporosis you need to evaluate for secondary causes of bone loss, which is prevalent is about 50% of individuals.” The most common secondary causes are Vitamin D and/or calcium deficiency. This is important because some agents used to treat osteoporosis can be harmful.

When a patient presents with osteoporosis, Dr. Camacho recommends comprehensive blood tests to measure kidney and liver function, Vitamin D level, serum calcium, phosphorus, and parathyroid hormone. Furthermore, a 24-hour urine measure for calcium excretion is advised.

During the group’s discussion, many questions related to treatment controversies are raised, including:

• Does Vitamin D treat osteoporosis, and how much should we give our patients?
• What does the research tell us about Vitamin D and osteoporosis?
• Why are there so many different recommendations about a target of optimal Vitamin D dose?
• How do I avoid idiopathic hypocalcemia?
• What should we consider when prescribing bisphosphonates, and is one superior?
• After treatment is started, how soon should the patient be re-scanned?
• What steps can be taken to ensure future measurements are consistent?
• How do I explain a “stable” osteoporosis result to my osteoporotic patient?