An osteoporosis diagnosis on DEXA scan is a call to act before a fracture happens. The good news: treatment is largely affordable, highly effective, and manageable through your day-to-day benefit with minimal complexity. Here's how.
The Honest Starting Point
Osteoporosis is not CDL or PMB. Your scheme is not obligated to fund specific osteoporosis treatment as a minimum benefit. All costs — medication, DEXA monitoring, specialist visits — come from your day-to-day benefit, MSA, or ATB.
The affordability picture is actually reasonable: generic alendronate (weekly oral tablet) is R80–R200/month and reduces fracture risk by ~50%. Calcium and vitamin D supplements are OTC at low cost. Annual DEXA monitoring may or may not be covered depending on your plan.
The more complex and expensive medications (denosumab, romosozumab) are for higher-risk patients and require more medical aid engagement.
Step 1: Confirm Your T-Score and Fracture Risk
Your DEXA report gives you: - T-score at the lumbar spine and hip - FRAX score (Fracture Risk Assessment Tool) — estimated 10-year probability of major osteoporotic fracture and hip fracture
Understanding these numbers helps you and your doctor decide on treatment intensity: - T-score −1.0 to −2.5 (osteopenia): lifestyle, calcium, vitamin D; bisphosphonate if FRAX risk is elevated - T-score ≤ −2.5 (osteoporosis): bisphosphonate indicated in most cases - T-score ≤ −2.5 + prior fracture (severe osteoporosis): aggressive treatment; consider denosumab or romosozumab
Step 2: Start Calcium and Vitamin D — OTC, Inexpensive
Calcium: 1,000–1,200mg elemental calcium per day (dietary + supplement combined). If dietary calcium is low (limited dairy, low legume intake), supplement with calcium carbonate tablets — available OTC at R50–R150/month.
Vitamin D3: 800–2,000 IU/day. Most South Africans have sufficient sun exposure but indoor workers and the housebound are often deficient. Supplement with cholecalciferol (D3) — OTC at R30–R80/month.
Both are available at Clicks, Dis-Chem, and pharmacies without a prescription. These are the foundation of osteoporosis prevention and should be started immediately.
Step 3: Start Bisphosphonate Therapy — Confirm Formulary Access
For most patients with T-score ≤ −2.5 or high FRAX risk, oral bisphosphonate therapy is first-line:
Alendronate 70mg once weekly (most common in SA): - Generic available: R80–R200/month - Take on an empty stomach with a full glass of water; remain upright for 30–60 minutes after - Reduces hip and spine fracture risk by ~50%
Confirm with your scheme: "Is alendronate (generic bisphosphonate) on my formulary? Is it covered under my acute or chronic medication benefit?"
A chronic dispensing arrangement (3-month supply) reduces dispensing fees — ask your pharmacist.
For patients who cannot tolerate oral alendronate (GI side effects): Annual IV zoledronic acid infusion (once a year; no oral compliance needed) may be appropriate. This is administered as a day procedure. Confirm cover under your scheme's day procedure benefit.
Step 4: Arrange Annual DEXA Monitoring
After starting treatment, DEXA is typically repeated at 1–2 years to assess response. Call your scheme:
"Is DEXA scanning covered under my plan, and can I have a repeat scan after starting bisphosphonate treatment? What is the benefit interval?"
If DEXA is not covered and cost is a concern: - Academic hospital radiology departments (Groote Schuur, Tygerberg, CHBAH) offer DEXA at significantly lower cost - Some community clinics in SA have basic densitometry available
Step 5: Address Falls Prevention — Non-Pharmacological
Fractures happen when osteoporotic bones meet falls. Reducing fall risk is as important as medication:
- Physiotherapy: Balance training, core strengthening, and gait assessment. Day-to-day funded (limited sessions).
- Home safety assessment: Remove loose rugs, improve lighting, install bathroom grab rails.
- Medication review with your GP: Many common medications increase fall risk — antihypertensives, sedatives, antihistamines, antidepressants. Review all medications with your GP.
- Vision check: Uncorrected vision impairment significantly increases fall risk. Annual optometrist visit is a day-to-day cost.
Step 6: Denosumab — For Higher-Risk Patients
Denosumab (Prolia 60mg, SC injection every 6 months) is prescribed for: - Patients who cannot tolerate or absorb oral bisphosphonates - Very high fracture risk (T-score ≤ −3.0, multiple prior fractures) - Renal impairment (where bisphosphonates are contraindicated)
Cost: R3,000–R4,500 per 6-monthly injection. Confirm formulary with your scheme.
Important: Denosumab must not be suddenly stopped — abrupt discontinuation causes a rebound increase in bone resorption and fracture risk. Always transition off denosumab to an alternative bone-protective therapy.
Support Resources
National Osteoporosis Foundation of South Africa (NOFSA): nofsa.co.za — patient support and information ADSA (dietitian referrals): adsa.org.za — dietary calcium assessment Council for Medical Schemes: 0861 123 267 | www.medicalschemes.co.za
Talk to Eldon
Osteoporosis is affordable to manage with generic bisphosphonates — the key is ensuring formulary access and DEXA monitoring coverage. The Check shows what each plan on our panel pays for this, side by side, and Eldon advises from there.
Review your plan for osteoporosis →