Osteoporosis and Vitamin D deficiency

The AACE/ACE recommends that pharmacological treatment should be initiated for: 1) patients with osteopenia or low bone mass and a history of fragility fracture at the hip or spine; *Fragility fractures are fractures that result from mechanical forces that would not ordinarily result in fracture (eg. fall from standing height) 2) patients with a T-score of ?2.5 or less in the lumbar spine, femoral neck, total hip, or 33% radius despite the absence of a fracture; 3) Patients with a T-score between ?1.0 and ?2.5 if the FRAX score 10-year probability for a major osteoporotic fracture is greater than 20% or for a hip fracture is greater than 3%. *Google FRAX score to calculate Medications: 1) Bisphosphonate (Alendronate, risedronate, and zoledronic acid) Table 3: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768298/ Contraindications to bisphosphonates include: -History of hypersensitivity to the bisphosphonate -Hypocalcemia -Chronic kidney disease with a glomerular filtration rate of less than 30 to 35 mL/min -Avoid oral bisphosphonates in patients with esophageal disorders such as achalasia, esophageal stricture, esophageal varices, Barrett's esophagus, inability to stand or sit upright for at least 30 minutes, history of bariatric surgery (Roux-en-Y gastric bypass). -History of atypical femur fracture secondary to bisphosphonates -History of osteonecrosis of the jaw secondary to bisphosphonates For patients at moderate to lower fracture risk, a drug holiday can be considered after three to five years of oral bisphosphonate use or after three annual doses of IV zoledronic acid.3,68 For patients at higher fracture risk, drug holidays can be considered after six to 10 years of oral bisphosphonate use or after six annual doses of IV zoledronic acid. Patients who are at higher risk could also consider using teriparatide or raloxifene during drug holidays. No study on how long drug holiday can be. 2) Denosumab (Prolia) - can cause hypocalcemia, so calcium levels should be corrected prior to treatment initiation. Repeat DEXA scan every 2 years while on treatment