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Osteoporosis Special Report

Osteopenia: To Treat or Not to Treat?

This Special Report is intended for readers interested in learning about the prevention, diagnosis, and management of osteoporosis.

Preosteoporosis, also known as osteopenia, refers to bones that are thinner than normal but aren't quite thin enough to be labeled osteoporosis. An estimated 10 million Americans have osteoporosis, but 34 million more -- 80% of them women -- may have osteopenia. The question for doctors: Should everyone with osteopenia be treated to ward off osteoporosis and fractures? If not, who really does need treatment and who can safely skip it?

How Real Is Your Risk of Osteoporosis? Bone mineral density (BMD) measurements are given as a T score. In general, a T score of -1 or higher is normal and a T score of -2.5 or less means that you have osteoporosis. A score between -1 and -2.5 suggests that you have osteopenia. A score in this range means that you may eventually develop osteoporosis or be at risk for a fracture.


But because you have osteopenia doesn't mean that you will definitely develop osteoporosis and suffer a serious fracture. Thus, taking bisphosphonates or other bone-building medications for osteopenia means that some people will be treated for a condition they would never have developed.


Consequently, many experts argue that most people with osteopenia don't need treatment. In fact, they say, such a strategy makes no sense when drug costs and potential side effects are taken into account. Instead, the general consensus is for selective, targeted treatment in people with osteopenia who have additional risk factors for fracture.

Predicting Your Fracture Risk. Until now, doctors relied primarily on the results of your latest BMD test in conjunction with your age, fracture history, and family history to determine whether you might be at high risk for a fracture. Now a new web-based computer program called FRAX takes much of the guesswork out of the process.

FRAX, which stands for Fracture Risk Assessment tool, was developed by the World Health Organization to calculate the odds of a fracture in the hip, wrist, shoulder, or spine in the next 10 years for anyone age 40 or older based on certain personal characteristics.


To use the tool, your doctor plugs in your hip (femoral neck) BMD and answers questions about other risk factors, including your age, gender, weight, and height; whether you've had a previous fracture or a parent who broke a hip; whether you're currently a smoker, are a long-term user of steroid-containing medicines, such as prednisone, or drink more than three alcoholic drinks a day; and whether you have rheumatoid arthritis or any other medical conditions, such as premature menopause or type 1 diabetes, that can lead to osteoporosis. FRAX then calculates your risk of developing a fracture in the next 10 years.


So what do you do with this information? Knowing your fracture risk will help you and your doctor more accurately determine whether you need to start taking an osteoporosis drug or whether you can safely wait. This is important because osteoporosis medications are not without risk. Two of the most commonly used drugs, alendronate (Fosamax) and risedronate (Actonel), have well established side effects, including abdominal pain and flu-like symptoms. Another popular osteoporosis drug, raloxifene (Evista), commonly causes hot flashes and leg cramps and may, in rare cases, cause clots in the veins or lungs.

For some people the benefits of taking an osteoporosis drug appear to outweigh the risks. Currently, the National Osteoporosis Foundation (NOF) recommends drug treatment for osteopenia in postmenopausal women and men age 50 and older who have at least a 20% risk of any major fracture (spine, forearm, hip, or shoulder) in the next decade or at least a 3% risk of a hip fracture.

The Bottom Line: Regardless of your future fracture risk, if you have osteopenia, it's important to incorporate nonpharmacological strategies for maintaining bone density into your routine. That means building bone strength by getting enough calcium and vitamin D and exercising.


  • Calcium and vitamin D. The NOF guidelines recommend that anyone over age 50 consume 1,200 mg a day of calcium and 800 to 1,000 IU a day of vitamin D. To get an adequate amount of calcium, choose plenty of dairy products such as low-fat milk, yogurt, and cheese. Nondairy sources include calcium-fortified orange juice and canned salmon with the bones. Calcium supplements are another option.
  • Exercise. The NOF guidelines also recommend that you perform regular weight-bearing and muscle-strengthening exercise. Any activity that works against gravity, including walking, jogging, or climbing stairs, stimulates the growth of new bone tissue. Or get into a regular tennis game, take a ballroom dancing class, or do heavy gardening; these, too, can help you build bone.


Posted in Osteoporosis on November 13, 2009


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