What is the treatment for osteopenia?

From the Guidelines

The primary treatment for osteopenia involves an individualized approach, considering lifestyle modifications and, in some cases, medication, with a focus on balancing benefits and harms based on the patient's baseline risk for fracture. When considering treatment, the following approach can be taken:

• Lifestyle changes (for all patients):
  • Increase calcium intake to 1000-1200 mg daily through diet or supplements
  • Ensure adequate vitamin D intake (800-1000 IU daily)
  • Regular weight-bearing and resistance exercises (30 minutes, 3-5 times per week)
  • Quit smoking and limit alcohol consumption
• Medication (for higher-risk patients):
  • Bisphosphonates are the first-line treatment: • Alendronate: 70 mg orally once weekly • Risedronate: 35 mg orally once weekly • Zoledronic acid: 5 mg IV infusion once yearly
  • The decision to start pharmacologic treatment with bisphosphonate in females over the age of 65 with low bone mass (osteopenia) should be based on an individualized assessment of the baseline risk for fracture, as suggested by the American College of Physicians 1.
• Follow-up:
  • Bone density scans every 2-3 years to monitor progress
  • Reassess fracture risk periodically Lifestyle modifications help improve bone density by providing necessary nutrients and stimulating bone formation. Medications like bisphosphonates work by slowing bone breakdown, allowing for increased bone density over time. Treatment decisions should be based on individual fracture risk, not just bone density scores, as emphasized in the living clinical guideline from the American College of Physicians 1. Early intervention can prevent progression to osteoporosis and reduce fracture risk. The American College of Physicians also recommends considering the benefits, harms, and costs of medications when making treatment decisions for osteopenic patients 1.

From the FDA Drug Label

Alendronate reduces bone resorption with no direct effect on bone formation, although the latter process is ultimately reduced because bone resorption and formation are coupled during bone turnover Long-term treatment of osteoporosis with alendronate sodium 10 mg/day (for up to five years) reduced urinary excretion of markers of bone resorption, deoxypyridinoline and cross-linked N-telopeptides of type I collagen, by approximately 50% and 70%, respectively, to reach levels similar to those seen in healthy premenopausal women Teriparatide injection is a prescription medicine used to: treat postmenopausal women who have osteoporosis who are at high risk for having broken bones (fractures) or who cannot use other osteoporosis treatments. Teriparatide injection can lessen the chance of broken bones (fractures) in the spine and other bones in postmenopausal women with osteoporosis

The treatment for osteopenia is not directly stated in the provided drug labels, but based on the information about osteoporosis treatment, it can be inferred that medications like alendronate and teriparatide may be used to treat osteopenia, as they are used to treat osteoporosis.

• Alendronate is a bisphosphonate that reduces bone resorption.
• Teriparatide is an anabolic agent that increases bone mass. It is essential to consult a healthcare provider to determine the best course of treatment for osteopenia, as the treatment may vary depending on the individual's specific condition and needs 2 3.

From the Research

Treatment for Osteopenia

The treatment for osteopenia involves a combination of lifestyle changes and nutritional supplements.

• Adequate dietary intakes of calcium, vitamin D, and protein are essential for maintaining bone health 4.
• Regular weight-bearing exercise, reduction in alcohol intake, and smoking cessation are also recommended 4.
• A daily intake of at least 1000 mg/day for calcium, 800 IU/day for vitamin D, and 1 g/kg body weight of protein is suggested for women aged over 50 years 4.

Lifestyle Interventions

Lifestyle interventions, including exercise, diet, and education, can have a positive effect on bone health in women at high risk of osteoporosis.

• Strength exercises have been shown to have a positive effect on fracture risk 5.
• Aerobic exercises have a positive impact on lumbar bone mineral density, fall, and balance 5.
• A combination of regular exercise and daily calcium and vitamin D supplementation is recommended for women with a high risk of developing osteoporosis 5.

Nutritional Supplements

Nutritional supplements, such as calcium and vitamin D, can help increase bone mineral density.

• Calcium supplementation may have little to no effect on total hip or lumbar spine BMD in premenopausal women 6.
• Vitamin D supplementation alone does not reduce or increase withdrawals for any reason between groups 6.
• Calcium plus vitamin D supplementation may not reduce or increase withdrawals for any reason 6.

Other Factors

Other factors, such as dietary protein, fruits, and vegetables, can also play a role in maintaining bone health.

• Dietary protein is an important nutritional consideration as it affects bone mineral density, trabecular and cortical microstructure, and bone strength 7.
• A balanced diet including minerals, protein, fruits, and vegetables is an important element in the prevention of osteoporosis and of fragility fracture 7.