Deciding on a treatment can be complicated. If your risk of breaking a bone is high, you will benefit from a treatment.
Healthcare providers weigh a number of factors to determine a recommendation for you. They also may use bone turnover markers (serum BSAP or P1NP to determine the rate of bone formation and urine NTx or serum CTx to determine rate of bone resorption) to help narrow your options. Bone resorption markers measure how active the osteoblasts are in removing bone tissue (resorbing) and bone formation markers measure how active the osteoblasts are in forming new bone.
Most all (90%) post-menopausal women will have elevated bone resorption marker (e.g., values in upper of the pre-menopausal normal range). Treatment options for patients with elevated fracture risk by FRAX™ or FORE-FRC™ and elevated bone resorption markers can be an antiresorptive, biologic or anabolic.
Less than 10% of patients with osteoporosis have low bone turnover and increased fracture risk. The only treatment recommended for patients with BSAP or P1NP in lowest of the premenopausal normal range is an anabolic to stimulate bone formation rather than an antiresorptive or biologic that will further decrease bone turnover.