From the Guidelines
Osteopenia treatment should prioritize a discussion of patient preferences, fracture risk profile, and benefits, harms, and costs of medications, particularly for women 65 years of age or older who are at a high risk for fracture. According to the American College of Physicians guideline update 1, the treatment of low bone density or osteoporosis to prevent fractures in men and women recommends offering pharmacologic treatment with bisphosphonates, such as alendronate or risedronate, to reduce the risk for vertebral fracture in men and women with clinically recognized osteoporosis.
Key Considerations
- The primary goal of osteopenia treatment is to prevent progression to osteoporosis and reduce the risk of fractures.
- Lifestyle modifications, including increasing calcium intake to 1000-1200mg daily and vitamin D to 800-1000 IU daily, regular weight-bearing exercise, smoking cessation, and limiting alcohol consumption, are essential.
- Medications, such as bisphosphonates, may be prescribed for those at higher fracture risk, with alendronate 70mg weekly or risedronate 35mg weekly being common options.
- Treatment decisions should be individualized based on fracture risk factors, including age, previous fractures, family history, and FRAX score calculation.
Medication Options
- Bisphosphonates, such as alendronate, risedronate, and zoledronic acid, are effective in reducing the risk of vertebral and nonvertebral fractures 1.
- Denosumab is also an option for reducing the risk of vertebral and nonvertebral fractures, particularly in women with osteoporosis 1.
- Selective estrogen receptor modulators, such as raloxifene, may be considered for women with osteoporosis, but their use is generally not recommended due to the risk of cardiovascular events 1.
Monitoring and Follow-up
- Bone density should be monitored every 1-2 years to assess treatment effectiveness.
- Treatment decisions should be re-evaluated based on patient preferences, fracture risk profile, and benefits, harms, and costs of medications.
From the FDA Drug Label
1.1 Treatment of Postmenopausal Women with Osteoporosis at High Risk for Fracture 1.2 Treatment to Increase Bone Mass in Men with Osteoporosis 1.3 Treatment of Glucocorticoid-Induced Osteoporosis 1.4 Treatment of Bone Loss in Men Receiving Androgen Deprivation Therapy for Prostate Cancer 1.5 Treatment of Bone Loss in Women Receiving Adjuvant Aromatase Inhibitor Therapy for Breast Cancer
The denosumab (SQ) is used to treat osteoporosis, but there is no direct information about treating osteopenia.
- The drug label mentions treatment of osteoporosis in postmenopausal women and men, as well as treatment of bone loss in certain conditions.
- However, osteopenia is not explicitly mentioned as an indication for denosumab (SQ) treatment 2.
From the Research
Osteopenia Treatment Overview
- Osteopenia is a condition characterized by low bone mass, which can increase the risk of fractures 3.
- Treatment for osteopenia typically involves a combination of lifestyle modifications and pharmacological interventions.
Pharmacological Interventions
- Antiresorptive therapies, such as bisphosphonates, denosumab, and selective estrogen receptor modulators (SERMs), are commonly used to treat osteopenia and osteoporosis 4, 3, 5.
- Teriparatide, an osteoanabolic agent, has been shown to be effective in reducing the risk of fractures 3.
- The choice of pharmacological therapy should be individualized based on factors such as underlying fracture risk, medical comorbidities, and medication burden 6.
Lifestyle Modifications
- A Mediterranean-type diet and daily consumption of 2 to 3 dairy products are recommended to maintain a normal calcium-phosphorus balance and bone metabolism 7.
- Avoidance of unbalanced Western diets, vegan diets, weight-loss diets in non-overweight individuals, alcohol consumption, and daily consumption of sodas is advised 7.
- Weight-bearing and resistance-training exercise, as well as fall prevention, are also important components of osteopenia treatment 4.
Treatment Considerations
- Polypharmacy is a common issue in older adults with osteoporosis, and treatment selection should take into account the patient's medication burden and potential interactions 6.
- Patients should receive a detailed explanation of the treatment goals and risks to maximize therapeutic benefit and compliance 5.