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Osteoporosis

Borderline Osteoporosis in an 83-Year Old

07/28/2008

Question:

My mother is 83 years old. She was hospitalized with severe Myasthenia Gravis (she had a crisis requiring ventilation) three years ago at which time she was put on high-dose prednisone. At that time, she had a baseline bone-density test which revealed very mild osteopenia. Since then, her MG has stabilized resulting in a lowering of prednisone usage from the original 100mg every other day (she was on this high-dose regimen and a subsequent taper for only about 6 mos.) to 10mg every other day. No Fosamax or drug like it was ever recommended to prevent osteoporosis.

Last month, a bone density test was repeated and showed excellent spine and arm scores (normal/amazing). However, my mother has a T-score of -2.43 in her hip which, I believe--although referred to in the report as "osteopenia"--is actually borderline osteoporosis.

My mother`s primary care physician thinks she is doing marvelously well in spite of the -2.43 T-score--and has recommended "no medication" at this time. Steps will be taken to try to lower the prednisone usage even further.

Although I am elated that my mother will not be adding another drug to her daily regimen (which already includes the alternate-day prednisone in addition to daily imuran and mestinon), I am concerned about whether or not low-dose Fosamax should, in fact, be considered. Again, the primary care physician thinks that, given my mother`s age (83), even for a person who has never taken prednisone, she is doing extremely well. She continues to take Caltrate/Vitamin D and to eat and drink calcium every day.

I am looking to you for some kind of justification/encouragement--in spite of my concern--to feel good about my mother`s score and her doctor`s decision to refrain from putting her on Fosamax or a drug like it to prevent further bone loss in her hip.

Aside from the MG, my mother is in extraordinarily good health--for any age.

Do you think the decision of her doctor to forego Fosomax or a drug like it--is one I should accept?

Thank you so much for your help.

Answer:

It is good your mother is doing so well with all she has experienced.  The risk of breaking a hip is high at 83 regardless of T-score and hip fractures have a high rate of complications the older the patient.  What you might do is calculate the "FRAX" score for your mother and discuss it with her physician:

Google "FRAX" and select the calculator tool.  Be sure to select the appropriate country and gender.  It will calculate your mother's percent chance of fracture in the next 10 years for any major fracture and in particular a hip fracture.  The level for intervention with a medication would be a risk of:

More than or equal to 20% for a major fracture

More than or equal to 3% for a hip fracture

For more information:

Go to the Osteoporosis health topic, where you can:

Response by:

Margery   Gass, MD Margery Gass, MD
Formely, Professor, Clinical Obstetrics & Gynecology
College of Medicine
University of Cincinnati