From the Guidelines
The treatment for osteopenia should focus on lifestyle modifications and, for high-risk patients, pharmacologic therapy with agents like bisphosphonates, as recommended by the American College of Physicians to prevent fracture risk. According to the American College of Physicians guideline update from 2017 1, the primary goal is to prevent the progression to osteoporosis and reduce the risk of fractures. Key lifestyle modifications include:
- Regular weight-bearing exercise, such as walking, jogging, or resistance training, for at least 30 minutes most days of the week to strengthen bones.
- A calcium-rich diet providing 1,000-1,200 mg daily, supplemented if necessary, to support bone health.
- Vitamin D supplementation of 800-1,000 IU daily to aid calcium absorption.
- Smoking cessation and limiting alcohol intake to no more than 1-2 drinks daily to reduce bone loss risk factors.
For patients at higher risk, particularly those 65 years of age or older, the decision to treat should be based on a discussion of patient preferences, fracture risk profile, and the benefits, harms, and costs of medications, as suggested by the guideline 1. Medications such as bisphosphonates (e.g., alendronate, risedronate) can be considered for reducing the risk of vertebral and nonvertebral fractures. The guideline recommends against routine bone density monitoring during the 5-year pharmacologic treatment period for osteoporosis in women but suggests a tailored approach for osteopenic women at high risk for fracture 1.
Given the potential benefits and harms of treatment, bisphosphonates are recommended for their efficacy in reducing fracture risk, with alendronate and risedronate being specifically mentioned for their ability to reduce both vertebral and nonvertebral fracture risk 1. The choice of medication should be individualized, considering the patient's specific risk factors, medical history, and potential side effects of the medications. Regular follow-up and assessment of fracture risk are crucial for adjusting the treatment plan as necessary.
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 In osteoporosis treatment studies alendronate sodium 10 mg/day decreased the markers of bone formation, osteocalcin and bone specific alkaline phosphatase by approximately 50%, and total serum alkaline phosphatase by approximately 25 to 30% to reach a plateau after 6 to 12 months 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. increase the bone mass in men with primary or hypogonadal osteoporosis who are at high risk for having broken bones (fractures) or who cannot use other osteoporosis treatments treat both men and women with osteoporosis due to use of glucocorticoid medicines, such as prednisone, for several months, who are at high risk for having broken bones (fractures) or who cannot use other osteoporosis treatments.
Treatment for Osteopenia
- The treatment for osteopenia may involve the use of medications such as alendronate or teriparatide to reduce bone resorption and increase bone mass.
- Alendronate is a bisphosphonate that binds to bone hydroxyapatite and specifically inhibits the activity of osteoclasts, the bone-resorbing cells.
- Teriparatide is an anabolic medication that can increase bone mass and reduce the risk of fractures.
- The choice of treatment will depend on the individual patient's needs and medical history, and should be made in consultation with a healthcare provider 2 3.
From the Research
Treatment for Osteopenia
The treatment for osteopenia is multifaceted and involves a combination of lifestyle modifications and pharmacological interventions.
- Lifestyle modifications include regular physical activity and a balanced diet rich in calcium, vitamins, and minerals 4, 5.
- Pharmacological interventions may include calcium and vitamin D supplements, bisphosphonates, selective estrogen receptor modulators (SERMs), denosumab, teriparatide, and calcitonin 6.
- Vitamin D therapy has been shown to be effective in improving bone mineral density (BMD) in patients with osteoporosis and osteopenia, particularly in those who are deficient in vitamin D 7, 8.
- Bone metabolism tests can help assess a patient's condition and guide treatment decisions, taking into account the relative benefits and risks of different treatments 6.
- Treatment decisions should be made on an individual basis, considering factors such as the patient's overall health, medical history, and lifestyle 6.
- Non-pharmacological strategies, such as fall prevention and maintenance of adequate vitamin D status, are also essential in preventing osteoporotic fractures 4.