What treatment options should be offered?
Appropriate treatment should take into account the proven effects of the different agents on reducing fracture risk. Antiresorptive therapies include bisphosphonates, estrogen, selective estrogen receptor modulators (SERMs), and calcitonin (Table). These agents act to lessen the risk of bone fracture by decreasing bone turnover, reducing bone loss, and stabilizing bone microarchitecture. Clinical trial data supports the enhancement of BMD and the antifracture benefit of these agents. A meta-analysis of all clinical trials of antiresorptive agents and calcium and vitamin D by the Osteoporosis Research Advisory Group (ORAG) showed that all these agents, including vitamin D (in those deficient), reduced the risk of vertebral fractures.¹⁶ This patient is at increased risk for both vertebral and nonvertebral fractures; therefore agents with proven efficacy at reducing both types of fractures are a reasonable consideration.