Dear Doctor Roach: I\u2019m a very healthy and active 74-year-old woman, and I\u2019m also quite proactive with my health. I get bone scans done every two years and have osteopenia in both my hips and spine. But because of a T12 fracture in 2018, which was followed by a kyphoplasty, I was recently recommended to see a specialist for more extensive blood work and scans.<\/p>\n
These scans also showed osteopenia, but in my wrists (which were never previously scanned), I have severe osteoporosis. With the severe compression between the T11 and T12 vertebrae, I know I need to do something. The first specialist recommended Forteo for two years. I got a second opinion, not because I didn\u2019t believe him but because this is such a big decision. The second physician recommended Prolia instead for five years, which would probably be followed up with a bisphosphonate.<\/p>\n
I have two questions: First, from what I\u2019ve read, it seems that once I\u2019m on these drugs, I\u2019ll be taking some of them for the rest of my life. Is this true? Also, I\u2019m very worried about the dangerous side effect of osteonecrosis of the jaw (ONJ). How often does this happen, and since I took Fosamax for five years (a decade ago) and didn\u2019t have any problems, is it unlikely that I\u2019d ever develop ONJ? — B.J.<\/p>\n
Answer: I agree that the balance of risks and benefits is strongly in favor of treatment. This is mostly because of your previous compression fracture, which puts you at a high risk for another fracture. The very low bone density in your wrists is less important to me than the vertebral body fracture, but a low bone-density score in the wrists predicts an increased risk of an arm fracture as well.<\/p>\n
It sounds like ONJ is a major concern for you. Denosumab (Prolia) does have a higher risk of ONJ than bisphosphonates like alendronate (Fosamax), but the absolute risk is still low — approximately 5 people for every thousand (0.5%) who take the medicine for 10 years. You need to compare this with a risk of another fracture without treatment, which is 10% to 20% within the first year.<\/p>\n
Your first specialist recommended teriparatide (Forteo), which is an excellent idea for you for two reasons: The first is that it very quickly reduces fracture risk, compared to either denosumab or alendronate. The second is that there isn\u2019t an increase in the risk of ONJ with teriparatide, since it\u2019s a common and effective treatment for ONJ.<\/p>\n
Many experts would treat you with teriparatide for 18-24 months, then switch you to a bisphosphonate. But they\u2019d also monitor your bone density scores and make ongoing decisions. Oftentimes, the bisphosphonate is stopped after five years, but it may be that you need it for longer or that the medication will need to be restarted.<\/p>\n
The evidence is strongly in favor of teriparatide given your fracture, and I recommend that you decide a course of action soon, as your risk of a repeat fracture is high without treatment.<\/p>\n
Dear Doctor Roach: Can you give me advice? I\u2019ve been on 5 mg of rosuvastatin since I was 36, but I was supposed to be started on it at 34. Should I ask my doctor to bump up the dose to 10 mg? — G.M.<\/p>\n
Answer: The dosing of statins like rosuvastatin is based on a goal-calculated LDL level, and this goal depends on the patient\u2019s risk. (Some experts use apolipoprotein B levels instead, although the results are similar.)<\/p>\n
In patients who are at a borderline-high to intermediate risk (with estimated risks between 3% and 10%), an LDL-C goal is typically less than 100 mg\/dL. For those who are at a high risk, a goal of less than 70 mg\/dL is more appropriate. People with existing heart disease should target 55 mg\/dL.<\/p>\n
Starting treatment at age 36 is still fairly young, so I wouldn\u2019t agonize over starting treatment later than what might\u2019ve been recommended.<\/p>\n
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.<\/p>\n
(c) 2026 North America Syndicate Inc.<\/p>\n
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