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osteopenia

Osteopenia is a general term for low bone mass. Etiology: 1) osteoporosis* a) primary 1] postmenopausal (I) 2] senile (II) 3] idiopathic in younger men & women b) Secondary 2) Cushing's syndrome (includes glucocorticoid therapy) 3) hyperthyroidism 4) hypogonadism in men 5) immobilization 6) chronic illness & lack of exercise [6] 7) chronic heparin administration 8) osteogenesis imperfecta 9) Primary hyperparathyroidism 10) Osteomalacia 11) Myeloma 12) Mastocytosis 13) Renal osteodystrophy * minimal trauma fracture makes diagnosis of osteoporosis Radiology: - bone mineral density (T-score -1 to -2.5) - repeat in 2 years if osteopenia not reaching criteria for treatment with bisphosphonate [5] Management: 1) calcium 1200 mg/day for men & women > 50 years preferably from dietary sources & vitamin D 600 IU/day, 800 IU/day recommended for elderly > 71 years [6] 2) alendronate reduces vertebral fractures with osteopenia at the femoral neck [2] - not cost-effective when only risk factors for fracture are age & bone mineral density [3] 3) initiate bisphophate treatment in postmenopausal women & in men age >= 50 years with low bone mass (T-score -1 to -2.5, osteopenia) at the femoral neck, total hip, or spine & 10-year hip fracture probability >= 3% or a 10-yr all major osteoporosis-related fracture probability of >= 20% based on the FRAX fracture risk assessment tool [4,5] 4) FDA approves vibrating belt to help women [7]

Specific

osteomalacia osteoporosis osteosarcopenia

General

sign/symptom

References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 500
  2. Journal Watch 25(8):64-65, 2005 Quandt SA, Thompson DE, Schneider DL, Nevitt MC, Black DM; Fracture Intervention Trial Research Group. Effect of alendronate on vertebral fracture risk in women with bone mineral density T scores of-1.6 to -2.5 at the femoral neck: the Fracture Intervention Trial. Mayo Clin Proc. 2005 Mar;80(3):343-9. PMID: 15757015
  3. Journal Watch 25(11):86, 2005 Schousboe JT, Nyman JA, Kane RL, Ensrud KE. Cost-effectiveness of alendronate therapy for osteopenic postmenopausal women. Ann Intern Med. 2005 May 3;142(9):734-41. Summary for patients in: Ann Intern Med. 2005 May 3;142(9):I36. PMID: 15867405 - McClung MR. Osteopenia: to treat or not to treat? Ann Intern Med. 2005 May 3;142(9):796-7. No abstract available. PMID: 15867413
  4. Prescriber's Letter 15(4): 2008 New guideline for prevention and treatment of osteoporosis from the National Osteoporosis Foundation Detail-Document#: 240404 (subscription needed) http://www.prescribersletter.com - CLINICIAN'S GUIDE TO PREVENTION AND TREATMENT OF OSTEOPOROSIS National Osteoporosis Foundation, 2008 http://www.nof.org/professionals/NOF_Clinicians%20_Guide.pdf
  5. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  6. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  7. Frellick M FDA Approves Vibrating Belt to Help Women With Osteopenia Keep Bone Strength. Medscape. January 25, 2024 https://www.medscape.com/viewarticle/fda-approves-vibrating-belt-help-women-osteopenia-keep-bone-2024a10001u2