EP280: Talking Osteoporosis With Doctor Cooley (Rhuematologist) Part 3

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Introduction Dr. Warrick Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, interviews Dr. Helen Cooley, a rheumatologist from Hobart, in the third episode of a series on osteoporosis. This episode focuses specifically on the medications used to treat osteoporosis, their mechanisms of action, implementation strategies, and how to guide patients through treatment options, using a postmenopausal woman with significant osteoporosis as a case study. Key Takeaways: Treatment decisions for osteoporosis must be patient-centered and fully involve the patient in weighing risks and benefits against their individual circumstances. Bisphosphonates (such as alendronate/Fosamax and risedronate) are long-established oral medications taken weekly that work by slowing bone turnover to prevent bone loss, with compliance being a significant challenge. Intravenous bisphosphonates like zoledronic acid offer convenience as an annual infusion lasting 3-5 years, but can cause significant aches and pains for 24-48 hours after administration. Denosumab (Prolia) is a monoclonal antibody injection given every six months that blocks osteoclast activity, but requires continuity of treatment as rapid bone loss occurs if injections are missed. Anabolic agents like teriparatide and romosozumab actually build new bone rather than just slow loss, but are currently only accessible after fracture and failure of other treatments with very low T-scores. The risk of osteonecrosis of the jaw (a serious dental complication) from bisphosphonates is rare at approximately 1 in 20,000 patients, significantly lower than the 30-40% fracture risk in untreated osteoporotic women. Treatment selection should consider patient preference regarding delivery method (oral tablets, intravenous infusions, or subcutaneous injections) and tolerance for potential side effects. Adequate vitamin D levels and normal kidney function are prerequisites for certain osteoporosis medications, particularly intravenous bisphosphonates. Pre-treatment dental evaluation and completion of necessary invasive dental work before starting bisphosphonates can prevent anxiety and reduce complication risks.