Osteopenia treatment
Osteopenia is referred to as a medical condition wherein bone mineral density is lower than the normal value. Bone mineral density is a measurement of the level of minerals in the bones, indicating how dense and strong the bones are. The World Health Organization (WHO) Scientific Group on the Prevention and Management of Osteoporosis specifically define osteopenia as a bone mineral density T-score between -1.0 and -2.5. Many doctors consider osteopenia as a precursor to osteoporosis.
As people grow older, bones become thinner. Starting in the middle age, existing bone cells are reabsorbed by the human body faster than new bones are made. As this happens, the bones lose minerals, mass and structure. This makes the bone weaker, thus increasing their risk of breaking. As compared to men, women are more prone to develop osteopenia and osteoporosis. This is due to the fact that women have lower peak BMD. The loss of bone mass also increases in women as hormonal changes take place at the onset of menopause.
Several factors may contribute to the development of osteopenia. Some of these factors include the following: eating disorders or metabolism problems that do not permit the body to absorb and use enough minerals and vitamins; chemotherapy or drugs such as steroids; radiation exposure; family history of the disease; smoking; limited physical activity; and excessive drinking of alcoholic beverages.
Osteopenia has no symptoms. The patient will not notice any pain or change as the bone becomes thinner. A bone mineral density test is usually performed to diagnose osteopenia. The dual-energy X-ray absorptiometry (DEXA) is the most accurate test for bone mineral density. Scans can also be performed with portable scanners using ultrasound and portable X-fay machines.
The treatment of osteopenia is quite controversial. Currently, candidates for treatment are those people with the highest risk of osteoporotic bone fracture on the bone mineral density and clinical risk factors. According to recommendations from the World Health Organization (WHO) Fracture Risk Assessment Tool (FRAX), consideration of therapy should be made for postmenopausal women and men older than 50 years of age. FRAX also recommends therapy in the presence of the following conditions: prior hip or verterbral fracture; T-score between -1.0 and -2.5 at the femoral neck or spine and a 10-year probability of hip fracture ≥3% or a 10-year probability of major osteoporotic fracture ≥10%year probability of; and clinicians’ judgment in combination with patient preferences indicate treatment for people with 10-year fracture probabilities above or below these levels.
Several drugs are used to treat osteopenia. Drugs commonly used are biphosphonates, selective estrogen receptor modulators and Teriparatide. Biphosphonates such as alendronate, risedronate and ibandronate, prevent the loss of bone mass. Bones are kept in balance by osteoblasts and osteoclasts. Biphosphonates work by stopping the digestion of bone by osteoclasts. Although osteoclasts normally destroy themselves through apoptosis, biphosphonates can encourage osteoclasts to undergo apoptosis.
Selective oxygen receptor modulators are drugs that act on the estrogen receptors. They are distinguished from pure receptor agonists and antagonists in the sense that their action is different in various tissues. This allows the possibility to selectively inhibit or stimulate estrogen-like action in various tissues. Some of selective estrogen receptor modulators that are used in the treatment of osteopenia are raloxifene, calcitonin and estrogen. Teriparatide is defined as a recombinant form of parathyroid hormone. Manufactured by Eli Lilly and Co., the drug is injected in the thigh or abdomen once a day. The U.S. Food and Drug Administration approved Teriparatide as the first agent for the treatment of osteoporosis that stimulates new bone formation. Clinical studies reveal that the actual benefits of these osteopenia drugs may be marginal.
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