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.