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Osteopenia Medications and Treatment

Medication Options for Osteopenia

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Updated April 28, 2014

pills and needles

pills and needles

Photo: John Foxx / Getty Images
Treating osteopenia is a controversial and hot topic. There are FDA-approved medications for the prevention of osteoporosis (and therefore for osteopenia). These medications are effective but some of them have serious side effects. Some doctors are hesitant to prescribe osteoporosis medications for osteopenia while others are aggressive in trying to slow bone loss. The real goal in treating both osteopenia and osteoporosis is preventing fractures, especially of the hip and spine. Doctors can calculate your 10-year fracture risk based on your current bone mineral density and other risk factors. That 10-year risk is the biggest consideration when thinking about taking medications for osteopenia (read more on osteopenia diagnosis and osteopenia prevention).

A side note (though an important one): Many health insurance companies do not recognize osteopenia as a condition that requires treatment, therefore they do not pay for medications (which can run around $1,000 per month).

Osteopenia Medications

As mentioned before, no medications are made specifically for osteopenia. Depending on your situation, osteoporosis medications may be suggested as a way of slowing bone loss as you age. Below, I’ll outline a some of the most common medications used in osteoporosis treatments that might come up when making decisions about how to manage osteopenia.
  • Bisphosphonates: Sold under the brand names Fosamax, Boniva, Reclast and Actonel, these medications can be taken orally or through an injection. These can slow the rate of bone loss and (sometimes) increase the bone mineral density in certain parts of the body (like your spine and hip). These are sometimes prescribed for people with osteopenia who are at high risk of developing osteoporosis because of long-term steroid use (for example people on steroid based treatments for asthma or arthritis). The bad news is that side effects of bisphosphonates can be severe and include nausea, pain, ulcers and more. Some people do better when bisphosphonates are given weekly or monthly. They can also be given by injection if the oral form isn’t tolerated well. One drug (Reclast) can be given once a year by injection at your doctor’s office. All these drugs have been developed for osteoporosis, so it gets really hard to tell what good they do for osteopenia.
  • Raloxifene: This drug works like estrogen in your body to help maintain bone mineral density, but without some of the risks of hormone replacement therapy (see below). The drug is only for use in women. Raloxifene has been shown to increase bone mineral density and decrease the risk of vertebral fractures.

Drugs Not FDA Approved for Osteoporosis Prevention

The following drugs are not FDA approved for treating osteopenia and preventing osteoporosis, though these are occasionally used and you may see mentions of them "out there":
  • Hormone Replacement Therapy: One main cause of bone loss in menopausal women is the reduction in the amount of estrogen produced by the body. It makes sense then that hormone replacement therapy (HRT) would help reduce bone loss. HRT is primarily used a preventative measure for women at high risk of osteoporosis. A range of studies and research have been done on the benefits and dangers of hormone replacement therapy. But, the jury’s still out, though more and more evidence is showing an increase in stroke, breast cancer, heart disease and other risks. The key would be to balance all the risks together and make a good decision (for example, if everyone in your family developed osteoporosis early, HRT might make more sense than if you had no family history).
  • Calcitonin: This is a nasal spray or injection that slows bone loss and helps relieve bone pain. Calcitonin is actually a hormone that is made in your thyroid and helps change the rate at which the body reabsorbs bones. The bisphosphanates, in general, work better and calcitonin is an option for people who can’t (because of side effects or other reasons) take other medications.
  • Teriparatide: This drug (called Forteo) is the latest weapon against osteoporosis. This can actually stimulate the body to grow new bones. It is prescribed for men and women who are at very high risk of hip fractures because of osteoporosis. Its long-term effects are still unknown and its use (under FDA guidelines) is restricted to two years.
  • Tamoxifen: This drug was originally used (and still is used) to treat breast cancer. It is a synthetic hormone that blocks the effect of estrogen on breast tissue while stimulating the effect of estrogen on other tissues (weird, but true). That means it can help prevent bone loss. It does have side effects (hot flashes, stomach problems, etc.).

Drug Treatment Bottom Line

No drugs are developed for osteopenia and some argue that osteopenia (some level of bone loss) is a natural part of aging. At times, a person with osteopenia may want to aggressively slow bone loss through medication. The way to figure out if you should is to have your doctor calculate your 10-year risk of hip (and spine) fracture. The World Health Organization (WHO) and the Osteoporosis Foundation have tables and charts to do this. The calculation considers factors like family history of osteoporosis, history of steroid use, etc. That calculation is your best guide to determine if medication should be used when you have osteopenia.

Read More About Osteopenia

Sources:

National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. Feb. 2008. Accessed July 23, 2008.

MedlinePlus Medical Encyclopedia: Osteoporosis

Osteopenia. Sundeep Khosla, M.D., and L. Joseph Melton, III, M.D., M.P.H. New England Journal of Medicine. Volume 356:2293-2300. May 31, 2007.

National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. 2008.

MedlinePlus Medical Encyclopedia: Bone mineral density test.

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