Osteoporosis – Moderate Risk – “Osteopenia”

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Osteoporosis – Moderate Risk – “Osteopenia”

geriguidesNovember 1, 2021List of Guides 0

In patients with no prior osteoporotic fracture* but with osteopenia on bone mineral density score (between -1.0 and -2.5) and with a low clinical risk factor score for fracture in 10 years (FRAX: <3% at hip and <20% any fracture), the risk of fracture is moderate.

* While osteoporotic fractures are generally those that would have not occurred in a young and healthy individual, major osteoporotic fractures are typically those of the hip, spine, forearm, and proximal humerus (though definitions vary).

Remember, BMD testing misses many who will fracture and the FRAX score has limitations

Guidelines recommend considering the use of bisphosphonates to prevent future fractures.
  • Per JCEM 2019 Guidelines
  • This is supported by a randomized controlled trial (with corresponding editorials here and here)
  • The decision on how to address fracture risk in an osteopenic range should be individualized to their underlying fracture risk factors and risk/burden of bisphosphonate therapy.
  • If bisphosphonate therapy is pursued, treatment doses and frequencies are the same as in osteoporosis.