What is the treatment for osteopenia (reduced bone density)?

From the Guidelines

Osteopenia treatment should focus on preventing progression to osteoporosis through lifestyle modifications and sometimes medication, with the primary approach including increasing calcium intake to 1000-1200mg daily and vitamin D to 800-1000 IU daily through diet or supplements, as recommended by the American College of Physicians guideline update from 2017 1. The treatment approach for osteopenia involves a combination of lifestyle changes and potential medication use. Key lifestyle modifications include:

• Increasing calcium intake to 1000-1200mg daily
• Increasing vitamin D intake to 800-1000 IU daily
• Regular weight-bearing exercise, such as 30 minutes of exercise, 3-5 times weekly
• Resistance training to maintain bone density
• Smoking cessation
• Limiting alcohol consumption to no more than 1-2 drinks daily For individuals at higher fracture risk, medications such as bisphosphonates (e.g., alendronate 70mg weekly or risedronate 35mg weekly) may be prescribed, as they slow bone breakdown and allow bone-building cells to work more effectively, as supported by the guideline update from the American College of Physicians 1. Additional considerations include:
• Fall prevention strategies, such as removing tripping hazards and improving lighting at home
• Regular bone density testing every 2-3 years to monitor treatment effectiveness
• Individualized treatment decisions based on fracture risk assessment, rather than solely on bone density measurements, as osteopenia represents a spectrum of decreased bone mass that may not always require medication, as noted in the guideline update 1. The American College of Physicians guideline update from 2017 1 provides strong recommendations for the treatment of low bone density or osteoporosis, including the use of bisphosphonates, denosumab, and teriparatide to reduce the risk of fractures in women with known osteoporosis. While the evidence from the Journal of Hepatology in 2016 2 provides some guidance on bone mineral density screening and treatment for patients with liver transplantation, the American College of Physicians guideline update from 2017 1 is more relevant and recent, and therefore takes precedence in guiding treatment decisions for osteopenia.

From the FDA Drug Label

Alendronate sodium 5 mg/day prevented bone loss in the majority of patients and induced significant increases in mean bone mass at each of these sites Alendronate decreases bone resorption without directly inhibiting bone formation The efficacy of alendronate sodium in men with hypogonadal or idiopathic osteoporosis was demonstrated in two clinical studies. Prolia significantly increased lumbar spine BMD compared to active-control at one year Prolia significantly reduced the incidence of new vertebral fractures at 3 years

The treatment for osteopenia (reduced bone density) is alendronate sodium or denosumab (Prolia), which can help prevent bone loss and increase bone mass.

• Alendronate sodium can be administered as a daily dose of 5 mg or 10 mg, or as a once-weekly dose of 35 mg or 70 mg.
• Denosumab (Prolia) is administered as a subcutaneous injection of 60 mg once every 6 months. Key benefits of these treatments include:
• Increased bone mineral density (BMD): Alendronate sodium and denosumab (Prolia) have been shown to increase BMD at various sites, including the lumbar spine, total hip, and femoral neck.
• Reduced risk of vertebral fractures: Denosumab (Prolia) has been shown to reduce the incidence of new vertebral fractures at 3 years.
• Prevention of bone loss: Alendronate sodium has been shown to prevent bone loss in the majority of patients and induce significant increases in mean bone mass. 3, 4, 5

From the Research

Treatment Options for Osteopenia

The treatment for osteopenia, a condition characterized by reduced bone density, can be managed through various methods, including:

• Counseling on weightbearing exercises and bone health 6
• Recommendation of calcium and vitamin D supplementation 6, 7, 8
• Pharmacological therapies, such as bisphosphonates, hormone therapy, or selective estrogen receptor modulators (SERMs) 6, 9, 8
• Antiresorptive drugs, including denosumab, which can increase bone density and prevent fractures 9, 7, 10
• Anabolic therapies, such as teriparatide, which can be considered for women at high risk of fracture 9, 7

Lifestyle Modifications

Lifestyle modifications can also play a crucial role in managing osteopenia, including:

• Weightbearing exercises to increase bone density 6, 7
• Adequate calcium and vitamin D intake 7, 8
• Smoking cessation 8
• Addressing modifiable lifestyle behaviors to minimize bone loss 8

Pharmacological Therapies

Pharmacological therapies can be effective in managing osteopenia, including:

• Bisphosphonates, which can prevent bone resorption and increase bone density 9, 8
• Denosumab, which can produce a continuous increase in bone mineral density and reduce the risk of fractures 10
• Raloxifene, which can be considered for women who do not tolerate first-line antiresorptive drugs 7
• Romosozumab, a new anabolic treatment for osteoporosis, which can be considered for individuals with severe disease and multiple fractures 7