What are the treatment options for osteopenia?

From the Guidelines

Treatment for osteopenia should be individualized, considering the patient's fracture risk profile, and may include lifestyle modifications and pharmacologic treatment with bisphosphonates, such as alendronate or risedronate, for those at higher fracture risk, as suggested by the American College of Physicians in their 2023 living clinical guideline 1. The primary recommendations for managing osteopenia include:

• Regular weight-bearing exercise, such as walking, jogging, or resistance training, for 30 minutes most days of the week
• Adequate calcium intake of 1,000-1,200 mg daily and vitamin D supplementation of 800-1,000 IU daily
• Dietary calcium can be obtained from dairy products, fortified foods, and leafy greens, while vitamin D comes from sunlight exposure and foods like fatty fish
• Smoking cessation and limiting alcohol consumption to no more than 1-2 drinks daily are also important For medication, bisphosphonates like alendronate (Fosamax) at 70 mg weekly or risedronate (Actonel) at 35 mg weekly may be prescribed for those at higher fracture risk, though they're not routinely given for osteopenia alone, as stated in the 2023 guideline 1. These medications work by slowing bone breakdown, allowing bone-building cells to work more effectively. Regular bone density testing every 2-5 years is recommended to monitor progression, as mentioned in the 2017 American College of Physicians guideline 1. Fall prevention strategies, including home safety modifications and balance exercises, are also crucial to prevent fractures in those with compromised bone density. In cases where bisphosphonates are contraindicated or not tolerated, denosumab may be considered as a second-line pharmacologic treatment, as suggested by the 2023 American College of Physicians guideline 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 Osteoporosis in Postmenopausal Women Osteoporosis is characterized by low bone mass that leads to an increased risk of fracture. Daily oral doses of alendronate (5,20, and 40 mg for six weeks) in postmenopausal women produced biochemical changes indicative of dose-dependent inhibition of bone resorption

The treatment options for osteopenia are not directly stated in the label, but alendronate is used to treat osteoporosis, which is characterized by low bone mass.

• Alendronate reduces bone resorption
• Alendronate has no direct effect on bone formation The label does not provide information on the treatment of osteopenia specifically, but it can be inferred that alendronate may be used to prevent the progression of osteopenia to osteoporosis. However, this is not explicitly stated in the label 2.

From the Research

Treatment Options for Osteopenia

The treatment options for osteopenia include:

• Lifestyle interventions such as exercise, diet, and education 3
• Calcium and vitamin D supplementation, which may benefit people with a high risk of deficiency 4
• Antiresorptive drugs such as bisphosphonates and denosumab, which remain first-line treatment options for osteoporosis 4
• Raloxifene, which may be considered in women who do not tolerate first-line antiresorptive drugs 4
• Romosozumab, a new anabolic treatment for osteoporosis, which is subsidised as second-line therapy for individuals with severe disease and multiple fractures 4
• Pharmaceutical treatment involving bisphosphonates, calcium and vitamin D3, denosumab, teriparatide, raloxifene, and strontium ranelate 5
• Non-pharmaceutical treatment including exercise, kinesitherapy, treatment at a health resort, physical therapy, and diet 5

Non-Pharmacologic Measures

Non-pharmacologic measures for osteopenia include:

• Good nutrition, especially adequate intake of protein, calcium, and vitamin D 6
• Regular physical activity 6
• Avoiding smoking and excessive alcohol consumption 6
• Reducing modifiable risk factors through dietary and lifestyle changes 6

Pharmacologic Therapy

Pharmacologic therapy for osteopenia includes:

• Estrogen agonists/antagonists 6
• Bisphosphonates 6
• RANK ligand inhibitors 6
• Parathyroid hormone-receptor agonists 6
• Inhibitors of sclerostin 6
• Combination of exercise, calcium, and vitamin D supplementation, which is effective for improving lumbar bone mineral density, risk of fall, and balance 3