From the Guidelines
Osteopenia screening is recommended for women aged 65 and older and men aged 70 and older, as well as for younger postmenopausal women and men aged 50-69 with risk factors, according to the most recent guidelines from 2022 1.
Key Recommendations
- Screening is typically done using dual-energy X-ray absorptiometry (DEXA) scanning, which measures bone mineral density.
- For those with normal results, rescreening is generally recommended every 2-5 years depending on individual risk factors.
- If osteopenia is detected (T-score between -1.0 and -2.5), follow-up screening may be recommended every 1-2 years to monitor for progression.
Risk Factors
- Low body weight (less than 127 pounds)
- Family history of osteoporosis
- Smoking
- Excessive alcohol consumption
- Long-term corticosteroid use
- Rheumatoid arthritis
- Previous fracture
Treatment
- Calcium supplementation (1000-1200 mg daily)
- Vitamin D (800-1000 IU daily)
- Weight-bearing exercise
- Smoking cessation
- Limiting alcohol intake
- Medication therapy is typically reserved for those with higher fracture risk or progression toward osteoporosis.
Importance of Screening
- Early screening and intervention are important because bone loss occurs gradually without symptoms until a fracture occurs, and preventive measures can significantly reduce fracture risk, as supported by previous guidelines 1.
Diagnosis and Monitoring
- The World Health Organization (WHO) defines normal BMD as a T-score ≥ -1.0, low bone mass or osteopenia as a T-score between -1.0 and -2.5, and osteoporosis as a T-score ≤ -2.5 1.
- The FRAX tool is used to assess fracture risk in patients with low bone mass, taking into account factors such as hip BMD, age, sex, height, weight, family history of hip fracture, smoking, steroid use, and alcohol use 1.
From the Research
Osteopenia Screening Guidelines
- Osteopenia is characterized by a bone mineral density (BMD) T-score between -1·0 and -2·5 2
- More than 60% of White women older than 64 years are osteopenic, and although fracture risk is often lower in osteopenic women than in those with osteoporosis, their greater number means that most fractures occur in osteopenic individuals 2
- The diagnosis of osteopenia is not an indication for either intervention or reassurance, but BMD is a risk factor that should be incorporated into a quantitative fracture risk calculation 2
Screening Recommendations
- All women 65 and older should be screened for osteoporosis, and consideration should be given to screening younger postmenopausal women with elevated risk 3
- Osteoporosis is diagnosed based on T score or a fragility fracture, and women with osteoporosis or who have a 10-year risk of any major fracture of 20% or hip fracture of 3% should be evaluated for causes of low bone density and treated with an osteoporosis-specific medication, lifestyle interventions, and calcium and vitamin D intake 3
Treatment Options
- Evidence from trials shows that oral and intravenous bisphosphonates cost-effectively reduce fractures in older osteopenic women 2
- Anti-osteoporotic treatment should be prescribed in patients with prevalent vertebral fractures, and in patients chronically using glucocorticoids, in a dosage of 7.5 mg per day or more 4
- Bisphosphonate therapy can reduce fracture risk and increase bone mineral density (BMD) in patients with osteopenia 5
Bisphosphonate Therapy
- Comparative clinical trials of bisphosphonates have examined changes in bone within central skeletal regions, but the effects of bisphosphonate treatment on the peripheral skeleton have also been studied 6
- A 2-year, open-label, parallel randomised control trial of three orally administered bisphosphonates (ibandronate, alendronate, and risedronate) found significant increases in central BMD sites, as well as significant changes in calcaneus BMD, total radius BMD, and quantitative ultrasound variables 6