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, as suggested by the American College of Physicians in their 2023 living clinical guideline 1. The primary approach to managing osteopenia includes:

• 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, which can be obtained through dietary sources like dairy products, leafy greens, and fortified foods
• Vitamin D supplementation of 800-1,000 IU daily, which can also be obtained through sunlight exposure and supplements
• Smoking cessation and limiting alcohol consumption to no more than 1-2 drinks daily For patients at higher fracture risk, medications like bisphosphonates (e.g., alendronate or risedronate) may be prescribed to slow bone breakdown and allow bone-building cells to work more effectively 1. It is essential to weigh the benefits and harms of pharmacologic treatment, considering the individual's baseline risk for fracture, as suggested by the American College of Physicians 1. Regular bone density testing every 1-2 years is recommended to monitor progress, and fall prevention strategies, such as removing tripping hazards at home and improving balance through exercises like tai chi, are also crucial components of comprehensive osteopenia management. The American College of Physicians' 2023 guideline suggests a conditional recommendation for starting pharmacologic treatment with bisphosphonate in females over the age of 65 with low bone mass (osteopenia) to reduce the risk of fractures, based on an individualized assessment of the baseline risk for fracture 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, including decreases in urinary calcium and urinary markers of bone collagen degradation Long-term treatment of osteoporosis with alendronate sodium 10 mg/day (for up to five years) reduced urinary excretion of markers of bone resorption

Treatment for Osteopenia:

• Alendronate sodium 10 mg/day can be used for the treatment of osteoporosis, which is characterized by low bone mass and increased risk of fracture.
• Alendronate reduces bone resorption and increases bone mass, which can help to prevent fractures.
• The treatment should be used under the guidance of a healthcare provider, and patients should be monitored for any adverse effects.
• It is essential to ensure adequate calcium and vitamin D intake during treatment with alendronate sodium.
• The use of alendronate sodium for the treatment of osteopenia is not explicitly stated in the provided drug labels, but it can be inferred that it may be used to prevent the progression of osteopenia to osteoporosis. 2

From the Research

Treatment Options for Osteopenia

• The treatment of osteopenia is not always necessary, as an osteopenic t-score does not in itself constitute a treatment imperative 3.
• Generally, osteopenia has to be associated with either low energy fracture(s) or very high risk for future fracture as assessed with risk calculators like FRAX to warrant specific osteoporosis therapy 3.
• Antiresorptive treatments, such as hormone replacement therapy, selective estrogen receptor modulators (SERMS), bisphosphonates, or Denosumab, are the treatments of choice in this group of patients 3, 4.

Pharmaceutical Agents

• Bisphosphonates are widely used in the treatment of osteoporosis and have been shown to reduce fractures in women with osteoporosis, with increasing evidence that they are also effective in women with osteopenia 4.
• Anabolic therapy, such as teriparatide and romosozumab, may be considered in patients with high or very high risk for fracture, particularly if they have failed anti-resorptive therapy 5, 6.
• The selection of osteoporosis treatment should be individualized and based on a variety of factors, including underlying fracture risk, medical comorbidities, medication burden, as well as fracture risk reduction profiles, modes of administration, and side effects of treatment options 7.

Lifestyle Modifications

• Correction of calcium and vitamin D deficiency and regular exercise, such as walking 3 to 5 miles a week, can often improve bone density in the hip and spine 6.