OsteoEd

Bisphosphonates

Heidi Powell, MD Literature reviewed August 06, 2006. Updated June 22, 2009

A 60-year-old postmenopausal woman brings in a DXA report that she had done at another facility. Her T-score at the hip is -1.9. She has no personal or family history of fractures. She thinks that she has gotten shorter and is concerned about osteoporosis. One of her friends is taking alendronate so she wants to know if she should be taking it, too.

Click an answer under each question.

1. You tell her she meets criteria for "low bone mass" or "osteopenia" (T-score -1 to -2.5) but that does not mean that she has osteoporosis. For osteopenic postmenopausal women like your patient, which of the following statements is true regarding alendronate or other bisphosphonates?

   • Option A Although they may decrease the incidence of vertebral fractures, the benefit does not outweigh the cost or risk of taking the medication.
   • Option B They decrease the incidence of both vertebral and nonvertebral fractures.
   • Option C They decrease the incidence of nonvertebral fractures only.

2. What additional study might help you determine whether treatment is indicated in this woman?

   • Option A Urine NtX
   • Option B Serum alkaline phosphatase
   • Option C T-spine films

3. A lateral spine film shows the following:

   

   She has a vertebral fracture and would benefit from treatment of osteoporosis. You counsel your patient regarding adequate calcium and vitamin D. Which of the following regimens do you recommend to her?
   • Option A Ibandronate 75 mg a month
   • Option B Alendronate 70 mg a week
   • Option C Risedronate 2.5 mg a day
   • Option D Alendronate 35 mg a week

4. What can you tell her about fracture risk reduction with alendronate in osteoporotic postmenopausal women?

   • Option A It decreases vertebral fractures by 30%
   • Option B It decreases both vertebral and hip fractures by more than 40%
   • Option C It decreases both vertebral and hip fractures by 30%

5. She wants to know what side effects she might experience with alendronate. Which of the following is a potential side effect of oral bisphosphonates?

   • Option A Muscle pain
   • Option B Osteonecrosis of the jaw
   • Option C Esophageal erosions
   • Option D All of the above

6. How long should the patient continue to take alendronate?

   • Option A 1 to 2 years
   • Option B 4 to 5 years
   • Option C More than 5 years

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