Osteoporosis is a disease involving weakening of bone increasing the risk of fragility fracture or fractures from insignificant trauma.  This weakening is estimated by measurement of bone mineral density (BMD) on a DEXA scan.  On these scans the BMD is reported as a T score, or the standard deviations in BMD compared to healthy 30 year olds.  T scores for osteopenia are from -1 to -2.5 and for osteoporosis from -2.5 or more.  What these scores mean is roughly the % of BMD loss.  For example, a T score of -2.9 represents a loss of about 29% of BMD while -1.5 represents a loss of about 15%.

A key question being answered in ongoing research is what percentage of BMD gain with treatment is needed to importantly reduce fracture risk.  One of the revelations has been that while standard drug therapies do improve BMD, it is often not to the degree to reduce fracture risk.  In a meta-analysis of the studies on two of the drugs used to treat osteoporosis, Romosumaub (Evenity)and Domosumaub (Prolia) addressed that question. (1) A meta-analysis pools the data from all available studies.

Both drugs improved bone mineral density at follow-up of at least 1 year.  Looking at fracture rates, only the Romosumaub significantly reduced the fracture risk.  Domosumaub, however, did not significantly reduce fractures risk.  It seems that the difference in how much each drug increases BMD resulted in the differences in fracture reduction.  Romosumaub resulted in 10-11% increases in BMD while the Domosumaub resulted in a 5% increase.

The conclusion seems to be that treatment must improve BMD by approaching 10% or more to reduce fracture risk.  Looking at the BMD gains associated with the difference drugs, only Romosumaub and Teriparatide/Forteo result in BMD gains approaching 10% within a 2 year window.

A non-drug treatment program combining different bone supporting supplements and pulsed electromagnetic therapy (PEMF) often produces >10% BMD gains in 12 months suggesting significant fracture risk reduction within that time window.

PEMF has been used commonly in difficult to heal fractures because it stimulates bone production.  Three case series studies all found >10% BMD gains with PEMF therapy.

Osteoporosis, like all age-related diseases, has left our health care system scrambling to find effective therapies.  It is estimated that 55% of those > 50 years of age have osteopenia or osteoporosis.  While drug therapy has been the mainstay of treatment, non-drug therapies are being studied and found to be a safe and effective alternative.