I am 72 years old and have been diagnosed with osteoporosis/osteoporotic (Iam not sure which as the report refers to both). The results of my tests are as follows:-
Indication: PTH
Risk Factor: Excess alcohol, fractured
wrist age 64, maternal hip fracture,
Secondary Osteoporosis (PTH)
Medication: OTC Vit D just started
Falls in the last 12 Months: 0
Weight: 58.8kg
Height: 159.5cm
Ethnicity: white
Age: 72
..
Bone mineral densitometry hip Lt :
Scanned Region:
..
AP Spine (L2, L3, L4)
BMD(g/cm2) = 0.676
T-score = -3.7
Z-score = -1.3
Classification = osteoporosis
..
Femoral Neck
BMD(g/cm2) = 0.467
T-score = -3.4
Z-score = -1.5
Classification = osteoporosis
..
Total Hip
BMD(g/cm2) = 0.531
T-score = -3.4
Z-score = -1.7
Classification = osteoporosis
..
WHO Fracture Risk Assessment Tool
10 - Year fracture Risk:
Major Osteoporotic Fracture =60%
Hip Fracture = 46%
..
Reported Risk Factors: previous
fracture, parental fracture, Secondary
Osteoporosis, alcohol use
UK, Neck BMD = 0.467, BMI = 23.1
..
FRAX Version 3.08. Fracture probability
calculated for an untreated patient.
Fracture probability may be lower if the
patient has received treatment.
..
Interpretation:
No technical difficulties reported with
the hip or spine scans. On analysis no
artefacts seen.
L1 has been excluded due to being > 1 SD
different to adjacent vertebrae
appearing small and bright on the AP.
The non dominant forearm could not be
scanned due to previous fracture.
At present due to BMD and risk factors
for osteoporosis, the patient has a high
risk of fracture in the next 10 years.
Possible dental issues have been
recorded and must be fully resolved
before starting any bisphosphonate
treatment.
..
The patient has not lost any height but
as L1 has been excluded due to appearing
small and bright a VFA scan was
performed today. No fracture identified.
Chronic degenerative changes noted but
grossly unchanged to CT 07/09/2021.
..
Recommendation:
The patient is osteoporotic.
Based on the referral information and
DEXA results, treatment is indicated
with Alendronate, Risedronate or Binosto
for 5 years provided there are no
contraindications, and it can be
tolerated. If the patient is unable to
take an oral bisphosphonate or they are
not tolerated, the current recommended
second line agent is Denosumab 60mg
subcutaneous injection, every 6 months
for 5 years. (NICE T161 \T\ 204)
Denosumab can be prescribed and
administered in the primary care
following this recommendation, but prior
to doing so, please consult the drug
prescribing information/summary of
product characteristics, patient
information leaflets and risk materials
(available online at the Electronic
Medicines Compendium)
In particular, the similar cautions
regarding dental treatment / risk of
osteonecrosis of the jaw and atypical
femur fractures exist for Denosumab as
oral (or IV) bisphosphonates. Denosumab
should be used with caution in patients
at risk of recurrent or severe
respiratory / urinary or skin or other
infections and in this situation (or if
it is not tolerated), IV bisphosphonates
may be an alternative or Strontium
Ranelate could be considered (please see
BNF for risk factors)
If treating with Denosumab for up to 5
years do not just stop as there have
been cases of an increased rebound
fracture risk shortly after stopping.
Discuss with Rheumatology in all cases
after a repeat DEXA scan to assess bone
density before stopping Denosumab.
..
If the patient fractures after 1 year of
treatment with a T-score -3 aged 65 or
a T-score of -4 refer to rheumatology to
consider future treatment options in the
osteoporotic clinic HUTDG/OST.
..
The patient has been given lifestyle
advice on bone health. They have been
advised to reduce their alcohol
consumption to within the daily
recommended limits.
If vitamin D deficient and treating with
a Bisphosphonate recommended treatment
regimen is based on:
A fixed loading regimen to provide a
total of \R\300 000 IU vitamin D, given
either as separate weekly or daily doses
over 6 - 10 weeks.
Followed by maintenance therapy
comprising vitamin D in doses equivalent
to 800 - 2,000 IU daily (occasionally up
to 4,000 IU daily), given either daily
or intermittently at higher doses.
Adjusted serum calcium should be checked
one month after completing the loading
regimen or after starting vitamin D
supplementation in case primary
hyperparathyroidism has been unmasked.
Calcium Supplementation: Under normal
circumstances calcium supplementation is
given alongside vitamin D
supplementation, however, if the patient
has a dietary intake of calcium that is
equivalent to the proposed calcium
supplementation; vitamin D
supplementation is available without a
calcium component. There may be rare
circumstances where there is a
contraindication to calcium and or
vitamin D supplementation. Always check
with the treating specialist if there
are any concerns.
..Follow-up:
Refer back for reassessment of fracture
risk in 5 years.
I am at present taking prescribed Vitamin D Adcal calcium carbonate and have also been prescribed Alendronic Acid 70mg to be taken once a week, but to date I am not taking this since I am loathe to take more medication than is absolutely necessary since my husband seems to take so many to counter-effect others.
My fractured wrist over 10 years ago was due to me being silly failing to leap over something of height!
I am active in the garden carrying heavy barrel loads of garden material and laying heavy garden slabs, etc. and this seems never ending.
I have recently had a masectomy to one breast and have hyperthyrodism due to a small biateral goitre but as I have no symtons to date I am refusing to take the 5mg carbimazole prescribed for this.
The only other medication I am taking at present is10mg rivaroxaban for the thrombosis of the leg (this may have been caused by the Astra Zeneca vaccine)
I believe I may have arthritus in one knee.
I am sorry if I have given more of my health details than may be necessary but maybe it will assist and any comments as to whether it is considered the Alendronic Acid prescribed is necessary will be greatly appreciated.
T score result 
Osteoporosis/alendronic acid 
Dexa scan results
Down to 7mg Pred
