Osteopenia: To Treat or Not To Treat?

The availability of an accepted and widely available diagnostic test and a set of effective treatment options for osteoporosis has challenged clinicians in deciding which patients should be treated. Once diagnosed when older women experienced a fracture of the spine or hip, osteoporosis is now recognized as a disorder of impaired bone strength that predisposes to fracture (1). The diagnosis of osteoporosis in postmenopausal women is now based solely on bone mineral density (BMD) values (T-score ≤ −2.5), according to the World Health Organization (WHO) criteria (2). In postmenopausal women with previous vertebral fractures or with BMD values consistent with osteoporosis, drug therapy reduces the incidence of important fragility fractures (3), and the cost-effectiveness of treating these women has been demonstrated (4-7). As a result, treating postmenopausal women who have osteoporosis is not controversial.

Whether to treat patients with osteopenia (T-score, −1 to −2.5) is much less clear. The concept of treating osteopenia is intuitively appealing. Most women with osteoporosis once had osteopenia, and therapy preserves bone mass and bone structure in women who do not have osteoporosis (8-11). When a specific diagnosis like osteopenia is made, both clinicians and patients are inclined to treat the diagnosis. The approval of drugs to prevent osteoporosis is easily interpreted as a mandate to treat …