By Dr Ananya Mandal, MD
Osteopenia is loss of bone mineral density and is often a precursor to more severe bone loss like osteoporosis. Bone loss in osteopenia may be reversed.
Treatment for osteopenia may be outlined as:
- Diet and nutritional strategies
- Exercises and physical activities
- Prescription medication
The main question is whether or not to treat osteopenia. Currently, candidates for therapy include those at the highest risk of osteoporotic bone fracture. This is determined using bone mineral density and clinical risk factors. As of 2008, recommendations from the National Osteoporosis Foundation (NOF) are based on risk assessments from the World Health Organization (WHO) Fracture Risk Assessment Tool (FRAX).
Who should therapy be offered to?
The recommendations suggest that therapy should be offered to postmenopausal women and men older than 50 years of age when present in addition to any of the following factors:
- History of hip or vertebral (spinal) fracture (this identifies individuals for osteoporosis)
- T-score of -2.5 at the femoral neck or spine. This is in absence of a secondary cause of bone loss like spread of cancers to the bone etc. (this identifies individuals for osteoporosis)
- T-score between -1.0 and -2.5 at the femoral neck or spine AND a 10-year probability of hip fracture ≥3% OR a 10-year probability of major osteoporotic fracture ≥10%. (This identifies individuals with osteopenia)
- Clinician’s judgement and patient preferences for treatment in people with 10-year fracture probabilities above or below these levels.
Bone mineral density test
A bone mineral density test using dual energy absorptiometry is advised at the age of 60 for all persons. If it is normal, it should be repeated ten years later.
On normal results of repeat tests, there is no need for further tests. If the test at age 60 shows osteopenia with a score of -1 to -1.7 standard deviations, a repeat test is advised at five years.
If initial cores in a woman is -1.8 to -2.4 (severe osteopenia) a repeat test in two years is advised.
If the score is -2.5 or less, the woman is osteoporotic and needs medical supervision and probably treatment with follow up bone mineral density measurements as medically appropriate.
Diet and nutritional strategies
Some foods need to be added to diet while yet others raise the risk of bone loss. Patients are advised to refrain from excessive alcohol, smoking and caffeine in diet (available from coffee, tea, soda, chocolate or sports and energy drinks).
In addition to dietary modification are the supplements. Dietary supplements useful for osteopenia include Calcium and Vitamin D. A calcium intake of 1,500 milligrams a day is recommended along with adequate vitamin D intake by diet or supplement along with a modest amount of sunlight exposure each day.
Sedentary lifestyle is associated with a higher risk of osteopenia and osteoporosis. But not every form of exercise is good for those with bone loss. In fact, some forms of exercise can cause 'spontaneous fractures' and should be avoided. In addition, exercise programs should be designed in a manner that there is minimal risk of falls and injuries.
Patient is advised to perform regular weight bearing exercise like walking, jogging, dancing, and other physical activities. Tai chi for example has been found to have positive effect on bones. It is also stress reducing and helps with balance. Moderately vigorous activities for at least 30 minutes a day at least five days per week is advised generally.
Medical therapy includes drugs like:
- Bisphosphonates including alendronate (Fosamax), risedronate (Actonel), and ibandronate
- Selective estrogen receptor modulators (SERMs) such as raloxifene (Evista)
- Estrogen (Premarin, Estrace)
Studies have shown that the actual benefits of these drugs may be marginal. Treatment with these drugs is usually begun after diagnosis of osteoporosis. Doctors are wary about overmedicating people with osteopenia.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)
Last Updated: Sep 5, 2016