Mrs. X is a 64-year-old white woman presenting to the Emergency Department after having slipped in the shower. Hip and leg x-rays reveal no fractures but there noted bone mass loss in the right hip. Her bone mineral density T-score is 2.4 at the hip and 2.1 at the spine with a Fracture Risk Assessment (FRAX) score indicating a 10-year probability of a major osteoporotic fracture of 45% and hip fracture of 19%. Mrs. X’s medical history is significant for hypertension and rheumatoid arthritis, for which she takes hydrochlorothiazide 25 mg orally daily and methotrexate 20 mg orally weekly. She also reports taking naproxen 500 mg orally twice daily but no other OTC medications.
What recommendations for pharmacologic treatment would you make? Include the reasoning behind your treatment recommendations.
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