Explanation:
Women are routinely screened for osteoporosis at the age of 65 or younger if they have other risk factors such as female sex, smoking, autoimmune disease such as rheumatoid arthritis, drinking alcohol or chronic steroid use, and a personal or family history of fractures. These individuals should receive treatment if they experience a low-impact fracture, have a history of vertebral fracture, or a low T score.
Generally, a T score −2.5 or less of the hip, femoral neck, or lumbar spine is diagnostic. For a T score −1 to 2.5, the Fracture Risk Assessment Tool (FRAX) determines whether a patient should be treated. Online FRAX calculators assess risk factors to determine if the patient has a 3% risk for a hip fracture or a 20% risk of fracturing the forearm, hip, shoulder, or spine within 10 years. This patient has a FRAX score of 4.2% for a hip fracture, which qualifies her for treatment. Younger postmenopausal women may be started on the selective estrogen receptor modulator (SERM) known as raloxifene and then transition to the more effective bisphosphonate in 5–10 years after treatment initiation. Although an estrogen agonist in the bone, raloxifene is an estrogen antagonist in the breast and decreases the risk for breast cancer.
Bisphosphonates are first-line treatment for osteoporosis, but they can cause osteonecrosis of the jaw, seizures, atypical fractures of the femoral shaft (A), and esophageal cancer in rare cases. They also cause vasomotor symptoms. Teriparatide, an alternative to bisphosphonates, is a form of parathyroid hormone that stimulates osteoblasts, thus can cause dysregulated bone remodeling (C) and Paget disease of the bone. Calcitonin, an antiresorptive medicine, is not as effective as other agents, particularly for women who are early postmenopausal. It is also not well tolerated due to its flushing and nausea (D) side effects.
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