From the Guidelines
The best treatment for osteopenia includes a combination of lifestyle modifications and, in some cases, medication, with bisphosphonates like alendronate or risedronate being commonly used to reduce the risk of fractures, as recommended by the American College of Physicians guideline update from 2017 1. When managing osteopenia, it's crucial to consider the patient's overall health, fracture risk profile, and preferences.
Key Lifestyle Modifications
- Regular weight-bearing exercise, such as walking, jogging, or resistance training, for 30-45 minutes most days of the week to build and maintain bone density
- Adequate calcium intake of 1,000-1,200 mg daily and vitamin D of 800-1,000 IU daily, either through diet or supplements
- Smoking cessation and limiting alcohol consumption to no more than 1-2 drinks daily to protect bone health ### Medication Considerations
- Bisphosphonates like alendronate (Fosamax, 70 mg once weekly) or risedronate (Actonel, 35 mg once weekly) are commonly used to slow bone breakdown and allow bone-building cells to work more effectively, as supported by the guideline's strong recommendation for their use in reducing the risk for hip and vertebral fractures in women with known osteoporosis 1
- The decision to treat osteopenic women 65 years of age or older who are at a high risk for fracture should be based on a discussion of patient preferences, fracture risk profile, and benefits, harms, and costs of medications, as suggested by the guideline's weak recommendation 1 ### Additional Measures
- Fall prevention strategies, including home safety modifications and balance exercises, are important complementary measures to reduce the risk of fractures
- Regular bone density testing every 1-2 years helps monitor progress and adjust treatment as needed, although the guideline recommends against bone density monitoring during the 5-year pharmacologic treatment period for osteoporosis in women 1
From the FDA Drug Label
Alendronate is a bisphosphonate that binds to bone hydroxyapatite and specifically inhibits the activity of osteoclasts, the bone-resorbing cells. 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 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 Long-term treatment of osteoporosis with alendronate sodium 10 mg/day (for up to five years) reduced urinary excretion of markers of bone resorption
The best treatment for osteopenia (reduced bone density) is not directly stated in the label, but alendronate is used to treat osteoporosis, which is characterized by low bone mass.
- Alendronate inhibits osteoclast activity, reducing bone resorption.
- It is used for the treatment of osteoporosis in postmenopausal women and men, as well as for glucocorticoid-induced osteoporosis.
- The typical dose for osteoporosis treatment is 10 mg/day. However, the label does not provide information on the treatment of osteopenia specifically, so no conclusion can be drawn about its use for this condition 2
From the Research
Treatment Options for Osteopenia
The treatment for osteopenia, a condition characterized by reduced bone density, can be approached through various methods, including lifestyle modifications, pharmaceutical interventions, and exercise.
- Lifestyle modifications, such as a proper diet, healthy lifestyle, and avoidance of modifiable risk factors like vitamin D deficiency, smoking, and excessive alcohol consumption, can significantly impact bone health 3.
- Pharmaceutical treatment options include bisphosphonates, calcium and vitamin D3, denosumab, teriparatide, raloxifene, and strontium ranelate, which are commonly used for osteoporosis but may also be considered for osteopenia in certain cases 4, 3, 5.
- Exercise is a crucial component of osteopenia treatment, with studies indicating that combined exercise, resistance exercise, aerobic exercise, and mind-body exercise can improve bone density, particularly in the lumbar spine, femoral neck, and total hip 6.
Exercise Interventions
Exercise interventions have been shown to be effective in increasing bone density and slowing down bone loss in patients with osteopenia.
- A systematic review and network meta-analysis found that mind-body exercise, such as yoga or tai chi, may be the optimal exercise type for improving bone density in the lumbar spine and femoral neck 6.
- Resistance exercise was found to be the most promising type for improving total hip bone mineral density 6.
- Regular physical activity, such as walking 3 to 5 miles a week, can also improve bone density in the hip and spine 7.
Pharmaceutical Agents
Pharmaceutical agents, such as hormone replacement therapy, selective estrogen receptor modulator therapy, and anti-resorptive therapy, may be recommended for the treatment of osteopenia, particularly in cases where lifestyle modifications and exercise are not sufficient.
- Bisphosphonates and denosumab are commonly used as first-line treatment options for osteoporosis and may also be considered for osteopenia in certain cases 4, 5.
- Anabolic therapy, such as teriparatide, may be considered for patients with severe osteopenia or osteoporosis who have failed anti-resorptive therapy 5, 7.