What is the treatment for osteopenia (reduced bone density)?

From the Guidelines

The treatment for osteopenia typically involves lifestyle modifications and sometimes medication, with a focus on individualized decisions based on fracture risk, not just bone density measurements alone.

Key Components of Treatment

• Regular weight-bearing exercise (like walking, jogging, or resistance training)
• Adequate calcium and vitamin D intake, with adults aiming for 1,000-1,200 mg of calcium daily and 800-1,000 IU of vitamin D daily 1
• Smoking cessation and limiting alcohol consumption are also crucial

Medication

For those with higher fracture risk, medications may be prescribed, including:

• Bisphosphonates like alendronate (Fosamax, typically 70 mg once weekly) or risedronate (Actonel, 35 mg weekly) 1
• These medications work by slowing bone breakdown, allowing bone-building cells to work more effectively

Fall Prevention and Monitoring

• Fall prevention strategies are crucial and include removing tripping hazards at home, using proper lighting, and wearing supportive footwear
• Regular bone density testing every 1-2 years is recommended to monitor the condition's progression 1

Individualized Treatment Decisions

Treatment decisions should be based on a discussion of patient preferences, fracture risk profile, and benefits, harms, and costs of medications, particularly for osteopenic women 65 years of age or older who are at a high risk for fracture 1

From the FDA Drug Label

The efficacy of alendronate sodium in men with hypogonadal or idiopathic osteoporosis was demonstrated in two clinical studies. Daily Dosing A two-year, double-blind, placebo-controlled, multicenter study of alendronate sodium 10 mg once daily enrolled a total of 241 men between the ages of 31 and 87 (mean, 63) All patients in the trial had either a BMD T-score less than or equal to -2 at the femoral neck and less than or equal to -1 at the lumbar spine, or a baseline osteoporotic fracture and a BMD T-score less than or equal to -1 at the femoral neck At two years, the mean increases relative to placebo in BMD in men receiving alendronate sodium 10 mg/day were significant at the following sites: lumbar spine, 5.3%; femoral neck, 2.6%; trochanter, 3.1%; and total body, 1.6%. Treatment with alendronate sodium also reduced height loss (alendronate sodium, -0.6 mm vs. placebo, -2.

The treatment for osteoporosis with alendronate sodium is:

• Daily dosing: 10 mg once daily
• Weekly dosing: 70 mg once weekly It is also used for the prevention of osteoporosis in postmenopausal women at a dose of 5 mg once daily or 35 mg once weekly. However, the provided text does not directly address the treatment for osteopenia. Since osteopenia is a condition characterized by low bone mass that is not severe enough to be classified as osteoporosis, the treatment may be similar, but it is not explicitly stated in the provided text. Therefore, based on the provided information, alendronate sodium may be used to increase bone mass in men with osteoporosis, but its use for osteopenia is not directly supported by the text 2, 2.

From the Research

Treatment Options for Osteopenia

• The treatment for osteopenia includes correction of calcium and vitamin D deficiency and regular exercise, such as walking 3 to 5 miles a week, which can improve bone density in the hip and spine 3.
• Pharmaceutical agents, including hormone replacement therapy, selective estrogen receptor modulator therapy, and anti-resorptive therapy, have been recommended for the treatment of osteopenia and osteoporosis 3.
• Bisphosphonates have been shown to cost-effectively reduce fractures in older osteopenic women, and may be considered for treatment in patients older than 65 years with a major osteoporotic fracture risk of 10-15% 4.
• Denosumab (Prolia®) has been compared to bisphosphonates, selective estrogen receptor modulators (SERMs), and placebo for the treatment of osteoporosis in postmenopausal women, and has been shown to increase lumbar spine and total hip bone mineral density (BMD) compared to placebo 5.

Lifestyle Modifications

• Regular weight-bearing exercise and a balanced diet with adequate calcium and vitamin D intake can help decrease the risk of fracture in postmenopausal women with osteoporosis 6.
• Avoidance of smoking, excessively low body weight, excessive alcohol intake, and fall risks at home are also important for maintaining bone health and reducing fracture risk 6.
• Emerging modifiable factors that may be important for bone health include B-vitamin, omega-3 fatty acid, soy isoflavone, and dehydroepiandrosterone supplementation 6.

Pharmaceutical Therapies

• Hormone replacement therapy (HRT), bisphosphonates, selective estrogen receptor modulators (SERMs), and calcitonin have been shown to stabilize and improve bone mineral density (BMD) and reduce fracture risk in postmenopausal women with osteoporosis 7.
• Bisphosphonates have been shown to have the largest risk reductions in fracture risk, and may be considered as a first-line treatment option for osteopenia and osteoporosis 7, 4.