Osteopenia: To Treat or Not To Treat?

  title={Osteopenia: To Treat or Not To Treat?},
  author={Michael R. McClung},
  journal={Annals of Internal Medicine},
  • M. McClung
  • Published 3 May 2005
  • Medicine
  • Annals of Internal Medicine
The availability of an accepted and widely available diagnostic test and a set of effective treatment options for osteoporosis has challenged clinicians in deciding which patients should be treated. Once diagnosed when older women experienced a fracture of the spine or hip, osteoporosis is now recognized as a disorder of impaired bone strength that predisposes to fracture (1). The diagnosis of osteoporosis in postmenopausal women is now based solely on bone mineral density (BMD) values (T-score… 

A 55-year-old woman with osteopenia.

Regardless of bone mineral density, regular exercise and adherence with vitamin D and calcium intake may reduce the risk of hip fracture, and decisions about pharmacological treatment to prevent fractures should be based on the patient's risk of fractures.

Tai Chi for osteopenic women: design and rationale of a pragmatic randomized controlled trial

The effectiveness of Tai Chi in reducing rates of bone turnover in post-menopausal osteopenic women, compared with standard care, is determined, and biomechanical processes that might inform how Tai Chi impacts BMD and associated fracture risks are preliminarily explored.

Osteoporosis and osteopenia in the distal forearm predict all-cause mortality independent of grip strength: 22-year follow-up in the population-based Tromsø Study

Men and women with low distal forearm BMD values, consistent with osteoporosis or osteopenia, had an increased mortality compared to normal BMD participants, and the association remained after adjustment for a range of health-related factors.

Efficacy of group-adapted physical exercises in reducing back pain in women with postmenopausal osteoporosis

The results suggest that group rehabilitation reduces back pain and improves functional status and quality of life in women with postmenopausal osteoporosis, maintaining these outcomes for 6 months.

The Safety and Efficacy of Early-Stage Bi-Weekly Alendronate to Improve Bone Mineral Density and Bone Turnover in Chinese Post-Menopausal Women at Risk of Osteoporosis

It was concluded that early intervention with 70 mg alendronate once every 2 weeks was safe, well tolerated and more effective than alfacalcidol alone (control) in increasing BMD and reducing bone turnover, and might prevent serious outcomes, such as fragility fractures, reduce rates of adverse effects and improve patient compliance.

OA06.02. Impact of Tai Chi exercise on multiple fracture-related risk factors in post-menopausal osteopenic women: a pilot pragmatic, randomized trial

Purpose Tai Chi is a mind-body exercise that shows potential as an effective and safe intervention for preventing fall-related fractures in the elderly and its potential to reduce bone loss and improve fall-predictive balance parameters in osteopenic women is evaluated.

Is the NHANES III femoral neck database discordant with the total hip and trochanteric region databases?

  • P. RochmisM. SheridanL. Perry
  • Medicine
    Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry
  • 2009

Alendronate reduced clinical and radiographic vertebral fractures in postmenopausal women with osteopenia.

Source Citation Quandt SA, Thompson DE, Schneider DL, Nevitt MC, Black DM. Effect of alendronate on vertebral fracture risk in women with bone mineral density T scores of −1.6 to −2.5 at the femora...



Cost-Effectiveness of Alendronate Therapy for Osteopenic Postmenopausal Women

The lifetime health benefits and costs of alendronate therapy to prevent fracture in postmenopausal women with osteopenia are estimated from $70000 to $332000 per quality-adjusted life-year.

Cost-effectiveness of risedronate for the treatment of osteoporosis and prevention of fractures in postmenopausal women

Intervention with risedronate was cost-effective in women aged 60 years and older and found for postmenopausal women aged 70 years and older with established vertebral osteoporosis, and if an additional, independent risk factor was assumed, treatment became cost- effective.

Treatment of Postmenopausal Osteoporosis

Clinicians and patients have several options for reducing the risk of fracture and achieving optimal dosing convenience, including alendronate and the selective estrogen‐receptor modulator raloxifene, which provide considerable vertebral fracture protection after 1 year of treatment and risedronate, which markedly reduces the rate of vertebral and nonvertebral fractures after 6 months of treatment.

The cost utility of bisphosphonate treatment in established osteoporosis.

The use of risedronate therapy in 75-year-old women at high risk of hip fracture leads to an improvement in quality of life with possible cost savings, and a QALY gain at a modest net cost.

Management of postmenopausal osteoporosis: position statement of the North American Menopause Society.

Osteoporosis therapy is to prevent fractures by slowing or preventing bone loss, maintaining bone strength, and minimizing or eliminating factors that may contribute to falls by reducing modifiable risk factors through lifestyle changes and, if indicated, pharmacologic therapy.

Alendronate Prevents Postmenopausal Bone Loss in Women without Osteoporosis: A Double-Blind, Randomized, Controlled Trial

A 3-year randomized, double-blind, placebo-controlled, dose-ranging study to evaluate the efficacy of alendronate therapy in preventing bone loss in healthy women who had recently experienced menopause.

Cost-effectiveness of raloxifene in the UK: an economic evaluation based on the MORE study

The analysis suggests that raloxifene is cost-effective in the treatment of postmenopausal women at an increased risk of vertebral fractures.

Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial.

In women with low BMD but without vertebral fractures, 4 years of alendronate safely increased BMD and decreased the risk of first vertebral deformity.

American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: 2001 edition, with selected updates for 2003.

  • S. HodgsonN. Watts R. Recker
  • Medicine
    Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
  • 2003
The AACE 2001 Medical Guidelines for Clinical Practice for the Prevention and Management of Postmenopausal Osteoporosis address the prevention, diagnosis, and management of postmenopausal osteoporo-sis, a disorder that is recognized as a major public health problem because of its physical and socioeconomic consequences.