When bone density is low enough to consider prescription options, hormone replacement therapy is usually the first recommendation for preserving bone density and for osteoporosis treatment. But not everyone can—or wants to—take estrogen or other HRT formulations. Fortunately, the last few years have brought a number of breakthroughs in pharmacological treatment of low bone density, and even more promising medicines are in the pipeline. The good news for anyone who still believes our grandmothers’ shrinking and fragility will inevitably be ours is that the new prescription therapies are more effective at countering lowered bone density than the more familiar cholesterol-lowering drugs are at protecting your heart. Numerous rigorous trials of the new medicines show that they can decrease the rate of fractures by up to 50 percent. For those with bone density already so low that supplements, diet, and exercise aren’t sufficient protection, that is good news indeed.
Most of these therapies can be combined with hormones for even better results, all work best if supported by a bone-healthy lifestyle, and most are designed to be used at the same time as calcium and vitamin D supplements. Of course, you should discuss all your options with your doctor, but you shouldn’t be relying on a medical professional to make your decisions for you. The goal of this chapter is to give you enough information to prepare you to make the discussion an intelligent one, and to allow you to ultimately make a confident, informed decision together with a medical professional. No matter how excellent a navigator your doctor may be, you, the patient, must be the captain of the ship. Your guiding question should be, how can I best help myself?
My goal for patients taking prescriptions to stop bone loss and protect bone density—in fact, for all my patients concerned about bone density—is to restore them to the levels expected in a healthy 30-year-old. An older person with frailer bones may take longer to attain that goal than a premenopausal woman with only a mild loss of bone density, but it is a goal within reach of anyone. I don’t accept osteoporosis as a normal part of aging. As we saw in the chapter on screening, bone density scans give you a pair of results—one score comparing you to ideal levels (for a healthy 30-year-old) and one comparing you to the average for your age and sex. The implication is that different results will raise different levels of alarm, depending on your age. But if we don’t accept bone loss in a 30- or 40-year-old, I see no reason why we should accept it in a 60- or 70-year-old, given our current knowledge and available options.