Should We Treat Osteopenia?
According to the World Health Organization and the National Osteoporosis Foundation, osteopenia is not a disease; until 1990 this word and condition didn't exist.
So where does this leave us, in our decision to treat osteopenia?
There are quite a few practitioners that feel treating this type of bone loss may be unnecessary. If this is correct, it would save us a tremendous amount of money, time, hassle, reactions to the medications and possibly even more dangerous outcomes if medications are taken too long. We now know that the gold standard for osteoporosis treatment, called bisphosphonates has caused things like subtrochanteric femur fractures, along with many other negative side effects like atrial fibrillation, bone and joint pain, gastrointestinal disorders, like GERD, and there remains a small risk of obtaining bisphosphonate induced osteonecrosis of the jaw. These are by far not all the side effects one could experience, so be sure that you are treating something that needs to be, so you aren't one who ends up with one of these other devastating disorders.
If osteopenia is normal age-related bone loss for some, then it can be viewed as a pre-cursor to osteoporosis, but not always. If you have any of the secondary causes for osteoporosis, treating osteopenia will do very little, if any thing, since the secondary cause needs to be treated and resolved before you're able to increase your bone mineral density. Treating bone loss with osteoporosis drugs will not increase bone mineral density until the secondary disorders are resolved.
Low vitamin D, calcium and other malabsorption problems also cause bone loss since your body is incapable of absorbing these nutrients our bones need. Until you get your malabsorption problem resolved you won't be able to benefit from these supplements.
Before proceeding with osteopenia treatment, but sure to have your physician check for all forms of malabsorption, secondary and medication causes for bone loss, as well as risk factors from genetics and your FRAX score.
Recently there was an article in the Los Angeles Times on this very topic and I'd like to share some of it with you, to help explain this dilemma.
According to the L.A. Times: "Osteopenia is normal - it's like gray hair," says Dr. Nortin Hadler, a rheumatologist at the University of North Carolina and author of "Worried Sick: A Prescription for Health in an Overtreated America."
"Hadler is one of many experts who say that the definition of osteopenia is overly broad and misleading. The way they see it, all women experience bone loss, but only a minority of those diagnosed with osteopenia are really on their way to developing osteoporosis."
"If you look at the way we define osteopenia, it's defined very crudely with very low sensitivity," Hadler says. "So almost everyone who is osteopenic is not in the group who's going to get fragility fractures. They're just in a greater risk group."
I feel that treatment is a personal decision which you reach with your physicians help; based on whether the risks outweigh the benefits and if supplements, life style changes, exercise and a good diet may produce the same effect of increased bone density, that medications may do.
However, if you do all these things and your t-scores don't improve, you need to re-visit your decision for treatment at a later date.
So if you are deciding whether to treat osteopenia, then you need to determine several things. Have you ruled out all secondary causes that can be treated separately? Have you had your doctor check for malabsorption problems? Will diet, supplements, exercise and life style changes help as much as prescribed medications? If the answer is yes, because you've seen the results, then you may be one who can do this instead of jumping on the osteoporosis medication bandwagon.
However, there remains a segment of the population who may need to take these medications, but before you decide if this applies to you, check to see if you're in the low t-score range, have a high risk for fracture or have fractured already. If this describes you, you may need to take some medication for a limited time to prevent further bone loss and debilitating fractures. We now know that most doctors feel that five years of a bisphosphonate (BP) treatment should be the limit, to prevent the problems seen with extended BP use, like atypical femur fractures or any of the other listed side effects.
Be sure to work with your doctor to determine all these things so you'll know you are covering all the bases in your total approach to bone loss. Good luck to you all!
- Osteopenia doesn't mean osteoporosis - so should you treat it? April 30, 2011; Amanda Leigh Mascarelli http://articles.latimes.com/2011/apr/30/health/la-he-midlife-osteopenia-20110430