Osteopenia Management Guidelines
Assessment and Diagnosis
- The American Academy of Family Physicians recommends that dual energy x-ray absorptiometry (DEXA) should be performed in all women 65 years and older, and in postmenopausal women younger than 65 with risk factors 1
- Fracture risk assessment may include use of FRAX or other tools to quantify fracture risk beyond BMD alone, as suggested by the Journal of Clinical Oncology 3, 4
Non-Pharmacological Interventions
- The American Academy of Family Physicians recommends a daily calcium intake of 1,000 mg for ages 19-50 and 1,200 mg for ages 51 and older 1
- The American Academy of Family Physicians also recommends a daily vitamin D intake of 600 IU for ages 19-70 and 800 IU for ages 71 and older 1
- A serum vitamin D level of 20 ng/mL is recommended for good bone health, according to the American Academy of Family Physicians 1
- Regular weight-bearing and muscle-strengthening exercises, such as those recommended by the Journal of the National Comprehensive Cancer Network, can help improve bone density 2, 5
- Balance training exercises, such as tai chi, physical therapy, and dancing, can help reduce fall risk, as suggested by the Journal of the National Comprehensive Cancer Network 2
- Smoking cessation and limiting alcohol consumption are also recommended to improve bone health, according to the Journal of Clinical Oncology and the Journal of Crohn's and Colitis 3, 6
Pharmacological Treatment
- The American Academy of Family Physicians suggests that pharmacological treatment should be considered when FRAX calculation shows a 10-year risk of hip fracture ≥3% or 10-year risk of major osteoporotic fracture ≥20% 1, 3, 4
- Bisphosphonates, such as alendronate, are first-line therapy for most patients with significant fracture risk, according to the Journal of Clinical Oncology 3
- Denosumab is an alternative for patients at high risk of fracture or who cannot tolerate bisphosphonates, as suggested by the American Academy of Family Physicians and the Journal of Clinical Oncology 1, 4
Special Populations
- Cancer treatments can accelerate bone loss, particularly those causing hypogonadism, according to the Journal of Clinical Oncology 3, 4
- For cancer survivors with osteopenia and additional risk factors, bisphosphonates or denosumab are preferred agents, as recommended by the Journal of Clinical Oncology 3, 4
- Liver transplant patients with osteopenia should perform regular weight-bearing exercise and receive calcium and vitamin D supplementation, according to the Journal of Hepatology 7, 8