Osteoporosis:
Sequoia Medical 360

Prevent Fractures. Preserve Independence.

Osteoporosis is low bone strength due to reduced bone density and micro-architectural deterioration. It’s often silent until a fracture occurs. Women after menopause and older men are at highest risk, but secondary causes are common and treatable..

Who’s at Risk?

Prior fragility fracture, parental hip fracture, low body weight

Early menopause, hypogonadism, hyperthyroidism/hyperparathyroidism

Chronic glucocorticoids, some cancer or seizure meds, PPIs

Inflammatory diseases, malabsorption, CKD, diabetes

Low vitamin D/calcium, smoking, excess alcohol, inactivity

Evaluation (What We Do Differently)

DXA at hip/spine (± forearm), VFA if height loss/back pain

FRAX fracture probability when appropriate

Labs for vitamin D, calcium, phosphorus, PTH, bone turnover, celiac screen if indicated

24-hour urine calcium to assess hypercalciuria

InBody 770 to monitor lean mass and tailor strength programming

Diagnosis

T-score ≤ –2.5 or fragility fracture at hip/spine = osteoporosis

Osteopenia (–1.0 to –2.5) + high FRAX may still warrant treatment

Always rule out secondary causes and address them

Treatment Plan (Personalized)

1) Lifestyle & Nutrition

Protein 1.0–1.6 g/kg/day; calcium 1000–1200 mg/day (diet first); vitamin D repletion

Resistance training (2–4×/week) + weight-bearing impact as tolerated

Balance training, vision/footwear/home safety to cut fall risk

3) Monitoring & Duration

DXA every 1–2 years; consider bone turnover markers to assess response

Reassess need for drug holiday with oral/IV bisphosphonates after defined periods

Calcium labs with denosumab; ensure timely dosing or consolidate before stopping

Outcomes We Track

Fewer fractures, improved T-scores, better lean mass, steadier gait, fewer falls

2) Medications (when indicated)

Bisphosphonates: Alendronate, risedronate, ibandronate, zoledronic acid (oral/IV options)

Denosumab (RANKL inhibitor): For those intolerant of bisphosphonates or needing greater antiresorptive effect

Anabolic/dual-action therapy:

Teriparatide / abaloparatide (build bone—usually up to 24 months)
Romosozumab (build + antiresorb; time-limited; CV risk discussion)

Sequencing strategy: Start anabolic in very high-risk patients (multiple fractures, very low T-scores), then consolidate with antiresorptive to retain gains

Steroid-induced osteoporosis: Early treatment, minimize steroid exposure

Schedule your osteoporosis evaluation in Bronxville.
Related Pages

https://sqmed360.com

Located in Bronxville, serving Westchester & all of New York State.

(914) 292-0300