History
- Discovered by DEXA on investigation of osteoporosis or following a fragility fracture.
- Patients are usually asymptomatic.
- Note that patients with low trauma vertebral fractures may have osteopenia on DEXA. These individuals are considered to have spinal osteoporosis.
Examination
- Often normal
Investigations
The diagnosis is made by DEXA on finding a T-score at either spine or hip of between -1.0 and -2.5 at any site.
Biochemistry and haematology
If you are considering referral for intravenous therapy (see below) the following tests are useful
- Urea and Electrolytes
- Liver function tests
- Serum 25(OH) D
M.A & S.R/H.B. 25-01-24
There is evidence that intravenous zoledronic acid can reduce the risk of fragility fractures in postmenopausal women with osteopenia aged >65. If your patient falls into this category; has a 10-year major osteoporotic fracture risk of more than 10%; has a eGFR of >35 and is willing to consider parenteral therapy, please refer to the osteoporosis service.
Counselling patients about treatment
Treatment should only be commenced following a discussion of the options with the patient, including the possibility of not having treatment given the fact that none of the treatments available can completely prevent fractures. You may wish to consider using the ORB calculator to work out the benefits of treatment for your patient with different drugs as part of this discussion. The ORB calculator is also available free as an iPhone app on Apple store and on Google Play for Androids. Note that if you are using FRAX (which only permits calculation of 10-year fracture risk), the risk of any osteoporotic fracture over 5 years is about 50% of the 10-year value.
In men and women under 65 years, and in the absence of vertebral fractures, osteopenia does not require treatment apart from lifestyle advice, but an interval DEXA is indicated to assess progression to osteoporosis (Please refer to DEXA page for suggested intervals). Bone targeted treatment of patients with DEXA osteopenia should be considered in the following groups.
- Postmenopausal women aged >65 years. These individuals may benefit from intravenous zoledronic acid ,which can be delivered in secondary care.
- Patents on long term glucocorticoids. These patients should be offered treatment (please refer to corticosteroid osteoporosis page)
- Patients with vertebral fractures on imaging. These patients should be treated as for osteoporosis (please refer to osteoporosis page)
Royal Osteoporosis Society (https://www.theros.org.uk/)
Management of osteoporosis and prevention of fragility fractures (SIGN 142)
Dietary calcium calculator. Calcium Calculator
Osteoporosis risk benefit calculator: ORB calculator
