What are treatment options and medications for osteopenia?
People with osteopenia should make certain important lifestyle modifications and ensure that their dietary intake of calcium and vitamin D (vitamin D2, vitamin D3, cholecalciferol) are adequate. Management of an underlying condition causing malabsorption, such as celiac sprue, can improve bone density. Not everyone with osteopenia requires treatment with prescription bone-building medication. This is because while 34 million people have osteopenia, and therefore the condition accounts for a large number of bone fractures, the absolute risk for fracture in any individual is low. So, if bone-building medications were prescribed to everyone with osteopenia, that would result in a large number of people who may never even have had a bone fracture taking medication for many years, exposing them to unnecessary expense and potential side effects.
If you have osteopenia, your doctor can determine if you need treatment with prescription medication. The decision to treat is made on a case-by-case basis depending on each individual. Factors other than bone mineral density can increase the risk of fracture, and these risk factors can be used to determine if a certain individual requires treatment for osteopenia. These include a parent who fractured their hip, previous or current treatment with corticosteroids (such as prednisone), thin and small-framed individuals, rheumatoid arthritis, smoking, and drinking more than two alcoholic beverages daily. Your doctor may use this information to calculate your risk of a bone fracture in the next 10 years. This risk can then be used to determine if treatment is necessary.
The diagnosis of osteopenia can be an eye-opening wake-up call to make certain lifestyle changes. Lifestyle modifications are an important part of the prevention and treatment of osteopenia and osteoporosis. These lifestyle changes include weight-bearing exercise (for example, walking or lifting light weights), quitting smoking, not drinking excessively, and ensuring an adequate daily intake of calcium and vitamin D. If dietary intake is not adequate, then supplements may be prescribed. The Institute of Medicine released the following guidelines on calcium and vitamin D intake on Nov. 30, 2010:
- 800 IU (international units) daily for women over the age of 71
- 600 IU daily for women in other age groups, men, and children
- 400 IU daily for infants under 12 months of age
- 1,200 mg (milligrams) daily for adult women over the age of 50 and men 71 years and older: At least 1,200 mg is recommended, including diet and calcium supplements. Calcium should be taken in divided doses, no more than 600 mg at once, to ensure optimal intestinal absorption.
- 1,000 mg daily for younger adult women (who are not breastfeeding or lactating) and adult men
The following prescription medications are treatment options for osteopenia and osteoporosis:
Alendronate (Fosamax), risedronate (Actonel), zoledronic acid (Reclast), and raloxifene (Evista) have an indication from the Federal Drug Administration (FDA) for the prevention of osteoporosis (such as for those with osteopenia), as well as for the treatment of osteoporosis. For raloxifene (Evista) and risedronate (Actonel), the doses used for osteopenia are the same as those used for osteoporosis. Zoledronic acid (Reclast) is an intravenous medication given yearly for the treatment of osteoporosis but every other year for the prevention of osteoporosis. Alendronate (Fosamax) is given as 10 mg daily or 70 mg weekly for osteoporosis, and the dose is halved for the prevention of osteoporosis (5 mg daily or 35 mg weekly).
Side effects of alendronate (Fosamax) and other bisphosphonates (risedronate, zoledronic acid and ibandronate) prescribed for osteoporosis and osteopenia are a subject of intense medical research and media scrutiny recently. The risks under scrutiny include unusual hip fractures and a jawbone problem known as avascular necrosis of the jaw. These side effects are rare. Generally these medications are used only when the benefits of preventing bone fractures far outweigh the risks.