Optimizing Osteoporosis Prevention and Therapy Selection, with Gina Woods, MD

Osteoporosis management in recent years has become defined not only by expanding therapeutic options, but by sharper risk stratification and a growing emphasis on prevention. At the Rheumatology Winter Clinical Symposium (RWCS) 2026 in Maui, Hawaii, Gina Woods, MD, Clinical Professor of Medicine and Director of the Osteoporosis and Preventive Bone Health Programs at the University of California San Diego, gave a talk sharing strategies for comprehensive bone care including treatment selection, sequencing, and the invaluable opportunity to prevent disease before it begins.

In her conversation with RheumatologyLive, Woods stressed that osteoporosis is, in many cases, preventable. Three FDA-approved classes—hormone therapy, selective estrogen receptor modulators (SERMs), and bisphosphonates—are available for prevention, yet remain underutilized. By intervening earlier, particularly in appropriate postmenopausal women, clinicians may be able to reduce the number of patients who later transition into high- or very high-risk fracture categories.

For patients with established osteoporosis, Woods emphasized a risk-based approach. Individuals are categorized as high risk or very high risk for fracture, with treatment decisions tailored accordingly. Those at very high risk, including patients with multiple prior fractures, fractures occurring on therapy, very low T scores, or a fracture within the past 2 years—are candidates for upfront anabolic therapy. Evidence supports sequencing anabolic agents first, followed by antiresorptive therapy, to maximize bone density gains and fracture risk reduction, particularly in treatment-naïve patients.

Woods also addressed patient hesitancy around rare but serious adverse effects associated with certain therapies, particularly bisphosphonates. She emphasized that when used appropriately, such as with intermittent intravenous zoledronic acid administered infrequently for prevention, the risk of atypical femur fractures or osteonecrosis of the jaw is exceedingly low. Clear communication about duration, dosing intervals, and individualized risk helps contextualize safety concerns and improve acceptance.

“When it comes to preventing osteoporosis, we've seen a renewed interest in menopause hormone therapy, just overall. So I think that will help in terms of preventing bone loss. And I think there's been a lot of messaging that patients are receiving that overall hormone therapy is quite safe, and so it's being used a lot more,” Woods said.

Reference

Woods G. Outside the box: Bone Health; new approaches and considerations. Presented at: RWCS 2026, held February 11-14 in Maui, Hawaii.