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For further information, see CMDT Part 26-18: Osteopenia
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Essentials of Diagnosis
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Patients are typically asymptomatic
Bone mineral density (BMD) below that for young normal adults, but less severe than osteoporosis
Diagnosis is by dual energy x-ray absorptiometry (DXA)
Fracture risk determined with FRAX tool
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General Considerations
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There is no absolute fracture threshold for BMD
Most patients with bone fractures are found to have osteopenia, rather than osteoporosis
Patients who are identified as osteopenic require an evaluation for causes of osteoporosis or osteomalacia and surveillance for worsening BMD
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Patients 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
Ribs
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DXA Bone Densitometry & FRAX
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T scores of –1.0 to –2.4 are diagnostic
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
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
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Adequate vitamin D intake is required to achieve serum 25-OH vitamin D levels above 30 ng/mL (75 nmol/L)
Calcium supplementation is not usually required, except for patients with unusually low dietary calcium intake
Lifestyle modifications may be required, including smoking cessation, alcohol moderation, strength training, and weight-bearing exercise
Measures that may prevent falls
Balance exercises, such as tai chi
Reduction of tranquilizer and alcohol consumption
Visual or walking aids when warranted
Removal of home tripping hazards
Adequate night lighting
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Iqbal
SM
et al. Role of bisphosphonate therapy in patients with osteopenia: a systemic review. Cureus. 2019;11:e4146.
[PubMed: 31058029]
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Zhang
Y
et al. Tai chi for treating osteopenia and primary osteoporosis: ...