From the Guidelines
Osteopenia can be partially reversed or stabilized with appropriate interventions, particularly in individuals at high risk for fracture, as evidenced by the potential benefits of treatment with bisphosphonates like risedronate in women with advanced osteopenia 1. When considering the reversal of osteopenia, it's essential to weigh the benefits and harms of treatment, taking into account patient preferences, fracture risk profile, and costs of medications, as recommended by the American College of Physicians 1. Key interventions include:
- Increased calcium intake and vitamin D supplementation to support bone health
- Regular weight-bearing exercise to stimulate bone formation
- Lifestyle modifications, such as quitting smoking and limiting alcohol consumption, to reduce bone loss risk factors
- Medications, like bisphosphonates, for individuals with high fracture risk or continued bone density decline The effectiveness of these interventions can vary by individual, with younger patients typically experiencing better outcomes 1. Regular bone density testing is crucial to monitor progress and adjust treatment as needed, allowing for early intervention and prevention of further bone loss, which is easier to achieve than completely restoring lost bone density. In women with osteopenia near the osteoporosis threshold, treatment with risedronate has been shown to reduce fracture risk significantly, with a 73% lower risk compared to placebo 1. While the current evidence is limited to post hoc evaluations of risedronate, it is believed that the benefit of fracture reduction is likely similar across all bisphosphonates, based on data from osteoporotic women 1.
From the FDA Drug Label
Figure 2: 3 At three years significant increases in BMD, relative both to baseline and placebo, were seen at each measurement site in each study in patients who received alendronate sodium 10 mg/day. In the two year extension of these studies, treatment of 147 patients with alendronate sodium 10 mg/day resulted in continued increases in BMD at the lumbar spine and trochanter (absolute additional increases between years 3 and 5: lumbar spine, 0. 94%; trochanter, 0. 88%). BMD at the femoral neck, forearm and total body were maintained.
The answer to whether osteopenia can be reversed is yes, as the studies show significant increases in BMD in patients treated with alendronate sodium.
- Key points:
- Increases in BMD were evident as early as three months and continued throughout the three years of treatment.
- Treatment with alendronate sodium 10 mg/day resulted in continued increases in BMD at the lumbar spine and trochanter.
- BMD at the femoral neck, forearm, and total body were maintained 2.
From the Research
Osteopenia Reversal
- Osteopenia is a condition characterized by low bone density, and it can be a precursor to osteoporosis 3.
- Research suggests that osteopenia can be reversed or improved through various treatments and lifestyle changes.
Treatment Options
- Bisphosphonates, such as alendronate and risedronate, have been shown to increase bone mass and reduce the risk of fractures in patients with osteoporosis 4, 5.
- Correction of calcium and vitamin D deficiency, as well as regular exercise, such as walking, can also improve bone density in patients with osteopenia 3.
- Hormone replacement therapy, selective estrogen receptor modulator therapy, and anti-resorptive therapy are other treatment options that have been recommended for osteopenia and osteoporosis 3.
Lifestyle Changes
- Regular exercise, such as walking 3 to 5 miles a week, can help improve bone density in the hip and spine 3.
- Maintaining a healthy diet rich in calcium and vitamin D is also essential for bone health.
Pharmaceutical Agents
- Denosumab (Prolia®) has been shown to increase bone mineral density (BMD) in postmenopausal women with osteoporosis, compared to placebo 6.
- Bisphosphonates, such as alendronate, ibandronate, and risedronate, have been shown to be effective in reducing fractures in older osteopenic women 7.