When will I need another dual x-ray absorptiometry scan?
Osteoporosis develops in fewer than 10% of older postmenopausal women using a 15-year screening interval for those with normal bone mineral density or mild osteopenia at an initial scan, with T-scores of –1.49 or higher, she noted. Therefore, the need for repeat dual x-ray absorptiometry (DXA) scans should be individualized, so some patients with normal bone density or osteopenia and few comorbidities and risk factors for osteoporosis may not need frequent DXA scans, she added.
Although little evidence exists to specifically demonstrate the value of monitoring bone mineral density during a 5-year drug treatment period, as is noted by the American College of Physicians 2017 clinical practice guideline published in Annals of Internal Medicine, Dr. Bolster said that a DXA scan showing loss of bone mineral density during treatment could indicate incorrect drug use or noncompliance, or a secondary cause for bone loss that may otherwise go unnoticed. For IV zoledronic acid in particular, a DXA scan at 3-4 years can determine whether a drug holiday is warranted, or for patients with severe osteoporosis, whether another 3 years of treatment is necessary. She suggested considering a DXA scan at 2-3 years with alendronate and at 3-4 years with IV zoledronic acid.
Will I need a new medication if I fracture while on treatment?
For patients who ask whether to change medications following a new fracture, Dr. Bolster said it is important to evaluate the patient’s compliance with the treatment regimen and also consider the presence of secondary causes of bone loss. Consideration can be given to keeping the patient on the same regimen because osteoporosis treatment regimens have demonstrated a 50%-70% fracture-risk reduction so they do not prevent all fractures, she said. “It is therefore reasonable, after confirming compliance and ruling out secondary causes of bone loss, to keep a patient on the same regimen following a fracture. For patients using denosumab, there is an increased risk of rapid bone loss and sustaining multiple vertebral fracture with missed doses or discontinuation,” she said.
It is important to evaluate patients who fracture while on therapy for secondary causes of bone loss, assess compliance, and consider strategies such as modifying the route of administration, seeking a different mechanism of action, or continuing on the same regimen, Dr. Bolster noted.
Dr. Bolster disclosed participation in clinical trials for Corbus, Cumberland, and Genentech, as well as research grants from the Rheumatology Research Foundation. She also disclosed serving on advisory boards for Gilead Sciences and Clinical Learning Designs, serving on the American College of Rheumatology’s Committee on Marketing and Communications, and holding investments in Johnson & Johnson.
Global Academy for Medical Education and this news organization are owned by the same parent company.