An 82-year-old postmenopausal woman treated with oral alendronate for osteoporosis

  • Left proximal humerus fracture 4 years prior due to a fall from standing height during a syncopal event

  • Left femural neck T-score of −2.5 on dual-energy x-ray absorptiometry

  • No history of celiac disease, paraproteinemia, or bariatric surgery

  • Renal function and vitamin D levels were normal

  • Patient concerned about falls and balance; another fall 6 months prior without fracture.

After ruling out secondary causes of osteoporosis, oral alendronate 70 mg once weekly was initiated.
Bone mineral density and bone turnover markers:
Before treatmentAt 3 monthsAt 1 year
 Lumbar spine−1.6−1.7
 Left femoral neck−2.5−2.4
 Right femoral neck−2.2−2.1
Bone turnover marker: C-terminal telopeptide of type I collagen520 pg/mL177 pg/mL
(66% reduction from baseline)
273 pg/mL
(48% reduction from baseline)