Patients with osteopenia are typically asymptomatic. However, bone pain can be present, particularly with osteomalacia. Osteopenia predisposes to low-impact and pathological fractures of vertebrae, hips, wrists, metatarsals, and ribs.
Patients with moderate to severe osteopenia (T scores between –1.5 and –1.4) require an evaluation for underlying causes of osteoporosis and osteomalacia. Testing should include a serum BUN, creatinine, albumin, calcium, phosphate, alkaline phosphatase, and 25-OH vitamin D; a complete blood count is also recommended. A serum PTH is obtained if the serum calcium is abnormal.
C. DXA Bone Densitometry and FRAX
Osteopenia is diagnosed by DXA bone densitometry with T scores of –1.0 to –2.4. The frequency of surveillance DXA testing for postmenopausal women and elderly men should be based on the T scores: obtain DXA testing every 5 years for T scores –1.0 to –1.5, every 3–5 years for T scores –1.5 to –2.0, and every 1–2 years for T scores below –2.0. Patients requiring high-dose long-term prednisone therapy should have DXA surveillance every 1–2 years. FRAX score should be determined with each DXA BMD determination.