What are the treatment options for osteopenia?

From the Guidelines

Treatment options for osteopenia include lifestyle modifications and medications, with a focus on regular weight-bearing exercise, adequate calcium and vitamin D intake, and consideration of bisphosphonates for those with higher fracture risk factors. The primary approach to managing osteopenia should involve lifestyle changes, including regular weight-bearing exercise such as walking, jogging, or resistance training for at least 30 minutes most days of the week. Additionally, ensuring adequate calcium intake of 1,000-1,200 mg daily and vitamin D supplementation of 800-1,000 IU daily is crucial. Quitting smoking and limiting alcohol consumption to no more than one drink daily for women and two for men are also important lifestyle modifications. For medication, bisphosphonates may be considered in some cases, including alendronate (Fosamax) 70 mg weekly, risedronate (Actonel) 35 mg weekly, or ibandronate (Boniva) 150 mg monthly, as noted in studies such as 1 and 1. However, medications are typically reserved for those with higher fracture risk factors such as previous fractures, family history of osteoporosis, or T-scores approaching the osteoporosis range (-2.0 to -2.5). Key considerations in the management of osteopenia include:

• Regular weight-bearing exercise
• Adequate calcium and vitamin D intake
• Consideration of bisphosphonates for high-risk individuals
• Lifestyle modifications to reduce fracture risk
• Regular bone density testing every 2-5 years to monitor progression and treatment effectiveness, as suggested by 1. It's also important to consider the potential benefits and harms of treatment, as outlined in guidelines such as those from the American College of Physicians 1, and to individualize treatment decisions based on patient preferences, fracture risk profile, and the benefits, harms, and costs of medications.

From the FDA Drug Label

The diagnosis can be confirmed by the finding of low bone mass, evidence of fracture on x-ray, a history of osteoporotic fracture, or height loss or kyphosis, indicative of vertebral (spinal) fracture Osteoporosis occurs in both males and females but is most common among women following the menopause, when bone turnover increases and the rate of bone resorption exceeds that of bone formation. 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 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.

The treatment options for osteopenia include:

• Alendronate: a bisphosphonate that binds to bone hydroxyapatite and specifically inhibits the activity of osteoclasts, the bone-resorbing cells.
• Teriparatide: an anabolic agent that increases bone mass and reduces the risk of fractures. It is essential to note that these medications are typically used to treat osteoporosis, and the treatment of osteopenia may involve lifestyle modifications and other interventions. The choice of treatment should be made on a case-by-case basis, considering the individual patient's risk factors and medical history. 2, 2, 3

From the Research

Treatment Options for Osteopenia

The treatment options for osteopenia include:

• Pharmacological agents such as bisphosphonates, which reduce bone resorption and have been shown to reduce fractures in women with osteoporosis and osteopenia 4
• Anabolic drugs that stimulate bone formation, such as teriparatide and abaloparatide, which have been shown to have greater anti-fracture efficacy and produce larger increases in bone density than anti-resorptive drugs 5
• Nutritional interventions, including a balanced diet with optimal protein and calcium intake, vitamin D sufficiency, and regular weight-bearing physical exercise 6
• Lifestyle modifications, such as avoidance of smoking and excessive alcohol intake, and fall prevention 7

Pharmacological Agents

Pharmacological agents used to treat osteopenia include:

• Bisphosphonates, which are widely used in the treatment of osteoporosis and have been shown to reduce fractures in women with osteoporosis and osteopenia 4, 5, 8
• Denosumab, a monoclonal antibody against RANKL that potently inhibits osteoclast development and activity, which has been shown to have similar anti-fracture effects to bisphosphonates 5
• Romosozumab, an anti-sclerostin monoclonal antibody that stimulates bone formation and inhibits resorption, which has been shown to have greater anti-fracture efficacy and produce larger increases in bone density than anti-resorptive drugs 5

Non-Pharmacological Interventions

Non-pharmacological interventions used to treat osteopenia include:

• Nutritional interventions, such as a balanced diet with optimal protein and calcium intake, vitamin D sufficiency, and regular weight-bearing physical exercise 6
• Lifestyle modifications, such as avoidance of smoking and excessive alcohol intake, and fall prevention 7
• Exercise programs, such as weight-bearing and resistance-training exercise, which can help to improve bone density and reduce the risk of fractures 7