The majority of patients with osteoporosis do not receive treatment.  This trend has been labeled the osteoporosis care gap.  The two primary drivers of this trend are:

• The lack of symptoms prior to fractures occurring
• Concern about the adverse effects of the available drug therapies

Studies looking at the osteoporosis care gap have found that almost 60%

of those diagnosed with the disease do not initiate treatment.  Osteoporosis typically causes no symptoms prior to a related fracture occurring.  This creates a tendency to think “there is nothing wrong”.

That thinking can lead to unfortunate problems. Of those with lighter disease, osteopenia, 34% or 1 in 3 will sustain an osteoporotic fracture within the next decade.(1)  That percentage climbs to 44% in those with osteoporosis.  A new study of those who had sustained a hip fracture found that 78.6% of those were previously recommended drug therapy did not initiate treatment. (2)

The second and the greatest driver of those with osteoporosis not beginning treatment is the known adverse effects associated with drug therapy.  The least significant of these adverse effects is the common upper digestive tract irritation with oral bisphosphonates such as Fosamax which is the typical first line treatment.  Injectables such as Prolia may be used to avoid that.

The more serious adverse effects include osteonecrosis of the jaw and transverse femoral fractures.  Osteonecrosis is an area where bone disintegrates.  Transverse femoral fractures are unusual horizontal fractures through the thigh bone.  Ironically, first line osteoporosis drugs improve bone density lowering fracture risk, but they cause bone to become brittle with extended use.  The defining timeline for when these drugs go from helping to hurting is poorly defined.

The good news is that effective non-drug treatment is highly effective for osteoporosis.  Several herbs have been shown to improve bone mineral density (BMD).  Pulsed electromagnetic frequency therapy (PEMF) has been shown to be highly effective in improving BMD.  While first line drug therapies improve BMD 5-7%, PEMF often improves it 15-20%.  This greater improvement is important as in early osteoporosis as defined by a T score of < -2.5 equates to a 20-25% loss of BMD.

There are 3 choices a patient has when faced with a diagnosis of osteoporosis:

1. Don’t initiate treatment
2. Drug therapy
3. PEMF with nutritional support

The riskiest choice is don’t initiate treatment.  That choice is the worst as it is associated with serious fracture risk.  The second choice may not appeal to many given the adverse effect potential.  This is where the third choice fits in!

1. Baek et al. 10-Year Fracture Risk in Postmenopausal Women with Osteopenia and Osteoporosis in South Korea. Endocrinol Metab. 2021;36(6):1178-1188.
2. Böck et al. (2026). Osteoporosis treatment gap prior to femoral fracture and prevalence of pharmacological risk factors: a prospective observational study. Archives of Orthopaedic and Trauma Surgery2026;146:10.1007/s00402-026-06401-5.