Abstract
By contrast to clinical trials exploring osteoporosis, clinical trials specifically designed for the osteopenic population are limited. Thus, less clinical data are available regarding treatment benefits and cost-effectiveness of treating a patient population with a bone mass density in the osteopenic range (T-score between -1 and -2.5). In this article, we aimed to highlight this high-risk population with a low bone mass density (BMD) susceptible to high fracture risk by reviewing different national and international guidelines for treating osteopenia. The cost-effectiveness of the therapy for the above-mentioned patient population is also discussed. By reviewing different clinical trials, we have specifically highlighted the role of bisphosphonate therapy for fracture risk reduction and increment in bone mineral density (BMD) in patients with osteopenia.
Highlights
BackgroundBone mass density (BMD) is an indicator of bone health and strength
Besides showing a fracture risk reduction, the Fracture Intervention Trial (FIT) trial on women with low bone mass density (BMD) concluded a significant increase in BMD at all sites in patients with no prior history of vertebral fractures taking alendronate 5 mg/day for an average of four years compared to subjects treated with placebo [30]
These results indicate the effect of bisphosphonate treatment on BMD is dose and duration independent
Summary
Bone mass density (BMD) is an indicator of bone health and strength. It is a good measure for determining risk of future fractures and an estimation of the body’s response to osteoporotic/osteopenic treatment. Besides showing a fracture risk reduction, the FIT trial on women with low BMD concluded a significant increase in BMD at all sites in patients with no prior history of vertebral fractures taking alendronate 5 mg/day for an average of four years compared to subjects treated with placebo [30]. These results indicate the effect of bisphosphonate treatment on BMD is dose and duration independent. For those not at higher risk, a drug holiday of two to three years can be considered, as long term bisphosphonate therapy often increases the risk of atypical femoral fracture but such rare events are outweighed by vertebral fracture risk reduction in high-risk patients [46]
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