Osteoporosis Treatment

Thyroid Institute of Utah – 801.396.0594

Osteoporosis does not have any noticeable symptoms. Most patients will not know they have osteoporosis until they suffer a painful bone fracture and receive X-rays, which reveal the internal structure of their bones. At the Thyroid Institute of Utah, our health and medicine specialists and doctors are using and further improving groundbreaking treatments for osteoporosis to try to prevent our patients from ever suffering fractures. As a team of doctors with 5,000+ total surgeries and 5,000+ total thyroid biopsies on our records, we are a trusted name throughout the state and the country.


To learn more about our work, or to see if we can help you, contact our clinic today.


Osteoporosis & Bone Strength Factors

Osteoporosis is defined in medical journals as “a silent skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture. Bone strength reflects the integration of 2 main features: bone density and bone quality.”

In turn, bone density and quality are effected by the efficiency of two internal bone processes:

  • Bone resorption by osteoclasts, or the removal of “old” bone cells.
  • Bone formation by osteoblasts, or the growth of new bone cells and mass.

As we grow up and until about age 25, bone formation is higher than bone resorption, meaning we gain bone mass. Beyond a certain age – approximately 25 – the bone resorption starts to occur faster than bone formation, and we slowly lose bone over the years. For women, the bone resorption is accelerated after menopause. People with bone resorption occurring at a rate much faster than formation may develop osteoporosis.

Diagnosis Osteoporosis

The accurate diagnosis of osteoporosis has proven difficult in the past. New technologies and expanded understanding of the condition itself has allowed doctors the better diagnose it in recent years. Our Utah osteoporosis treatment specialists have studied and learned these diagnosis techniques.

Osteoporosis diagnosis can be completed if you have any of the following:

  • DXA scan showing T-score of -2.5 or below in the lumbar spine, femoral neck, total hip, and/or 33% (one-third) radius
  • Fragility fracture (fracture of any bone after falling from standing height, other than skull, cervical spine, ankle, hand/foot) regardless of bone mineral density
  • Osteopenia or low bone mass based on DXA scan, and high FRAX fracture probability (more than 20% risk of fracture at any site, and more than 3% risk of hip fracture, in the next 10 years)

What Causes Osteoporosis?

Age is the most significant risk factor for osteoporosis. Medical histories suggest that post-menopausal females are more prone to osteoporosis, but it is worth noting that it is nearly as common in males. Most of the time, no other cause of osteoporosis, other than age, can be found. However, osteoporosis is often linked or suspected to be related to an underlying medical condition, which may be left entirely undiagnosed unless tests are used to diagnosis it specifically.

Osteoporosis may be linked to or caused by these underlying medical conditions:

  • Vitamin D deficiency
  • Calcium deficiency
  • Diabetes
  • Excessive cortisol
  • Hyperthyroidism
  • Hyperparathyroidism
  • Hypogonadism
  • Hypophosphatasia
  • Alcoholism
  • Eating disorders
  • Chronic liver disease
  • Malabsorption (such as celiac disease)
  • Malnutrition
  • Medications
  • Immobilization
  • Myeloma
  • Certain cancers, organ transplantations, rare genetic and non-genetic disorders

It is up to the physician to consider these disorders during the evaluation of osteoporosis, and, if there is high clinical suspicion, test for them. Here at the Thyroid institute of Utah, prior to starting treatment for osteoporosis, we order a comprehensive laboratory panel to exclude the most common causes of secondary osteoporosis, and add tests as needed based on our clinical suspicion. This is in full compliance with the National Osteoporosis Foundation, American Academy of Clinical Endocrinologists, and Endocrine Society guidelines.

Should I Get Treatment for Osteoporosis?

If you are diagnosed with osteoporosis based on any of the aforementioned criteria, we would likely recommend that you should start treatment. The sooner you treat osteoporosis, the lower the chances that you will suffer a fracture or painful bone breakage.

We have separated our many available treatment options into two umbrella categories:

  1. Antiresorptive agents: Medications that slow down bone metabolism. They slow bone resorption more than they slow down bone formation, so the overall outcome is increased bone mass and fracture prevention. These agents include the bisphosphonates (alendronate, risedronate, zoledronate, etc), and denosumab. Overall, they reduce the risk for spinal fractures by 50-70%, and the risk of hip fracture by 35-40%, depending on the agent.
  2. Anabolic agents: Medications that accelerate bone metabolism. For the first few months of treatment, they accelerate bone formation more than they accelerate bone resorption, so the overall outcome is increased bone mass and fracture prevention. These agents include teriparatide and abaloparatide. Overall, they decrease the risk of vertebral fractures by 65-85%, and significantly improve the hip bone density. Data is still being gathered and studied to assess if there is significant hip fracture prevention.

Osteoporotic fracture of the humerus (upper arm).

Osteoporotic fracture of the hip.​

Osteoporotic vertebral (spinal) fractures.​

Treatments

Osteoporosis treatments available at our Provo health center include:

  • Bisphosphonates (oral every week, or IV every year)
  • Denosumab (subcutaneous injection every 6 months)
  • Teriparatide and Abaloparatide (subcutaneous injection daily)

Possible Treatment Side Effects

Every medical treatment has side effects. Osteoporosis treatments are no exception. We do our best to minimize side effects and prevent complications, but you should be fully aware of possible side effects regardless. You can call 801.396.0594 to ask one of our medical professionals about other potential side effects that may exist due to your unique health conditions.

Potential side effects that may occur from the following treatments include:

  • Bisphosphonates:
    • Osteonecrosis of the jaw (ONJ, defined as the presence of exposed bone in the maxillofacial region that did not heal within 8 weeks after identification by a healthcare professional), can happen with oral or IV bisphosphonates, at a rate of 1/10,000 to 1/100,000 patients per year. There is no evidence that stopping treatment for patients planned to undergo invasive dental procedures helps decrease the risk of ONJ, but can be considered for extensive procedures.
    • Atypical femur fracture (AFF), which is a very low/no trauma femoral fracture can happen. However, for every 100 fractures prevented, only 1 AFF will happen.
    • There is a possible mildly increased risk of Atrial Fibrillation
    • To prevent ONJ and AFF, bisphosphonate holidays are considered
    • Some patients may experience a short lived flu like reaction (fever, muscle aches, etc.)
  • Denosumab:
    • There is a risk of ONJ, but it appears to be very low.
    • There is a risk for allergic reaction.
    • If treatment is stopped without transitioning to another agent, all the benefit accumulated with denosumab over the years will most likely be lost, which can lead to a high risk for fractures. Thus, we do not perform holidays with denosumab, and we always transition to another agent if we plan to stop this medication.
  • Teriparatide and Abaloparatide:
    • The most common side effects (but not very common overall) include high blood calcium, high urine calcium, dizziness, nausea, headache, palpitations, fatigue, upper belly pain, vertigo.
    • There is a black box warning due to the theoretical risk of osteosarcoma (bone cancer), based on data from mice that received extremely high doses. There is no increased risk of osteosarcoma in humans, based on years of experience with Forteo. However, due to this theoretical risk, no patient should get more than 2 years of treatment with these 2 agents combined.

Measures You Can Take to Prevent Fractures

In addition to seeking osteoporosis treatment, you should also take other measures to try to prevent bone fractures. You should make sure you take adequate amounts of vitamin D, with the daily recommended dose being ~800-2000 units. You should also consume an adequate amount of elemental calcium through your diet or supplement meant use, with the daily recommended dose being a total of 1000-1200 mg of elemental calcium. This can be achieved by taking at least three servings of dairy products daily and participation in a graded resistance training exercise program. Anyone can benefit from these health measures as well, not just people prone to osteoporosis.

More information can be found at the National Osteoporosis Foundation website:

Professional Osteoporosis Treatment Doctors in Utah

Ready to learn more about osteoporosis treatments? Contact us today if you have been diagnosed with osteoporosis. We will perform a thorough clinical evaluation, including targeted history and physical exam and laboratory evaluation to exclude secondary causes of osteoporosis. We like to take the time to get to know patients and discuss in detail the optimal treatment that meets your individual needs.


Get more information by calling 801.396.0594 and asking about our osteoporosis care.