Issue 5: Medications, fear, and facts

Issue outline

Main idea

Fear is understandable. The goal is not to dismiss side effects. The goal is to compare the risk of treatment with the risk of untreated fragile bone in a specific person.

What to teach

Explain antiresorptive and anabolic categories, route, duration, sequencing, rare side effects, and why stopping some medicines requires a plan.

Patient action

Ask what problem the medicine is meant to solve, how success will be monitored, how long treatment is expected, and what happens next.

Questions to include

• What is my fracture risk without medication?
• Which medication category fits my situation?
• What side effects are common versus rare?
• How long would I take it?
• What is the follow-up plan?

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References

1. Compston JE, McClung MR, Leslie WD. Osteoporosis. Lancet. 2019;393(10169):364-376. doi:10.1016/S0140-6736(18)32112-3.
2. Morin SN, Leslie WD, Schousboe JT. Osteoporosis: a review. JAMA. 2025. doi:10.1001/jama.2025.6003.
3. Black DM, Geiger EJ, Eastell R, et al. Atypical femur fracture risk versus fragility fracture prevention with bisphosphonates. N Engl J Med. 2020;383(8):743-753. doi:10.1056/NEJMoa1916525.
4. Nayak S, Greenspan SL. A systematic review and meta-analysis of sequential treatment strategies for osteoporosis. Osteoporos Int. 2026. doi:10.1007/s00198-025-07717-5.