Wondering if you have any advice re osteoporosis and meds. I want to pass on taking any meds. I’m 66F, nationally competitive Masters weightlifter, no fractures but I had two full tendon tears that were repaired Apr 2025 with anchors. Surgeon said he didn’t see any issues with my bone quality. DEXA in Aug 2026 showed osteoporosis in hips, osteopenia in spine, TBS bone quality score showed spine has one vertebra that’s worse than the others. I train with coach 3x/wk, walk 50K steps/wk, yoga 2-3x/wk (for balance work), 13%bf, sleep/HRT/nutrition all good. My question is do the standard osteoporosis meds apply to someone like me? Or is this some kind of big pharma plan to reduce fracture risks without regard to a person’s personal efforts to reduce their own risk?
Hi there,
First off, really remarkable work in all of your physical efforts - keep it up!
To your question: the various available medications do indeed lower fracture risk when applied as they were in their randomized clinical trials. However you are not the type of person who was well-represented in the clinical trials of these medicines, simply because there are not a lot of people like you! This makes it harder to apply those research study results to estimate just how likely you are to benefit from treatment, compared with someone else who may have similar bone density numbers on a DEXA scan, but without all of those lifestyle behaviors.
As with many other conditions like high blood pressure, high cholesterol, diabetes, etc., a person’s “absolute” likelihood of benefit from these kinds of treatments depends on their baseline risk – higher risk people get more overall benefit compared with people at lower risk.
The other challenge is that among people who receive treatment, we can’t ever know who successfully prevented a fracture, versus who was never going to have one anyway. So while I can understand folks’ tendencies towards conspiratorial mindsets like a “big Pharma plan”, it is just extremely complex in practice to deal entirely in probabilities and uncertainty like this. People are always free to decline medical treatment and accept whatever risk there may be as a result.
One of the most important things for people with osteoporosis is maintaining overall physical function and avoiding falls. However, I have also consulted with people who have surprising/unexpected low bone density despite healthy lifestyle habits including strength training – in some cases severe osteoporosis (T scores well below -3) that definitely merited medical treatment, as well as further evaluation to look for other identifiable and treatable causes of osteoporosis – since not all cases are “typical” postmenopausal osteoporosis. These conversations get well beyond the scope of the forum here, though.
Thanks for your quick and detailed response, Dr B. I think people would benefit from more insight into how the DEXA stats work (ie who are they comparing my results to in order to come up with a standard deviation- much heavier? much younger? no fractures?). And yes there are not too many like me but I have participated in some studies that universities conduct at our national meets among 55+ competitors. Hopefully new information will be developed so the right people are medicated and not unnecessarily frightened into using them.