Beatrice Edwards, MD: The Best Way to Treat Osteoporosis

Dealing with the challenges of osteoporosis is difficult for geriatric patients. The combination of medication, therapy, and hazardous risk reduction is necessary for the patient to be able to live comfortably.

In an interview with MD Magazine®, Beatrice Edwards, MD, deputy associate chief of staff of geriatrics and extended care for the Central Texas Veterans Health Care System, explained the best way to treat these patients.

MD Mag: What is the optimal balance of medication and non-pharmacological therapy to treat osteoporosis?

Edwards: Osteoporosis, in terms of fracture protection, medications are absolutely necessary. Calcium and vitamin D are the mainstay of therapy and that is what the placebo arm has used in many of the clinical trials.

Even in the clinical trials, you see the number of fractures. So, you need the antiresorptive agent to reduce the fracture risk.

As you look at the older population, however, falls become an issue and 30% of women over the age of 65 fall in a given year. So, you have to have an intervention, which is non-pharmacologic, either physical therapy or Tai Chi, checking a vitamin D status, making sure that their vitamin D replete as ways of reducing fall risk.

In addition, in some of the more senior patients, you're going to do a home safety evaluation to make sure they don't have environmental hazards like low-level lighting, cluttered hallways, throw rugs.

So, it's a number of interventions you're going to implement in order to reduce falls

and fractures.

MD Mag: What is the biggest challenge patients face after being diagnosed with osteoporosis?

Edwards: I think 1 of the biggest challenges is misinformation. Much of the information that has gone to the media, that has been aired in all the channels and all the newspapers has been the fear of antiresorptive agents, the fear of osteonecrosis of the jaw.

That is a significant barrier when you speak to women in terms of the fear that the agents are

going to cause side effects and for them. The risk is almost commensurate with a benefit.

No one has really sat down and looked at the numbers with them and when we work with the American Society of Bone and Mineral Research on a paper on long-term safety of antiresorptive agents of bisphosphonates, we looked at the risk of suffering a fracture, which in a lifetime is 50%.

Then a hip fracture is about 15%, we compared that to the risk of suffering a car accident, which is like 1 in 10,000. Then the risk of suffering osteonecrosis of the jaw, which is like 1 in 60,000.

Then we looked at atypical femur fractures and the risk of that was similar to the risk of being murdered. So, we don't walk around thinking that we're going to be murdered and so that's what I explained to patients.

As I would show them the bar chart, they would say no one has ever explained that to me. That is a significant issue because if you explain even to older patients you know the medicine will work very quickly and will be very effective reducing fractures they understand that.

Another issue that they raised is if the insurance is going to cover it and then the number of medications they take. Having the medications that you can administer every 6 months or once a year are really optimal for them. They already have a number of pills that they're taking that you don't want to add to their burden.

So, I think those are the biggest of the fear the coverage and then polypharmacy are the biggest barriers that they encounter. They're not afraid of being screened, they're not afraid of being asked what they consume in their diet.

They're okay with that and I think when you really tell them you know we can preserve your quality of life you can preserve your independence they really get it.