Even though osteopenia is a very low-risk condition, in the absence of significant symptoms and signs, one can be reassured and consider avoiding medications, especially biostimulants that may accelerate bone loss, and exercising regularly.
About 18.7% of the US population is osteopenic (with osteoporosis at some point in their life). About 17.4% of men in the US are osteopenic. Younger people tend to be less likely to be osteopenic or have a lower prevalence of osteopenia. The absolute number of new cases of osteopenia (including new cases of osteoporosis) could be substantial.
In this population, the most common precipitating factor involved in the development of osteopenia was recent chemotherapy. Osteopenia developed quickly, was responsive to increased calcium intake, and the response appeared to be maintained 3 years after therapy had been discontinued.
Osteopenia is defined as an absolute or relative bone mineral density of 20 or less than the upper limit of the age and gender matched reference values without the use of dual x-ray absorptiometry. A population-based osteopenia screening should be offered to adults who had no baseline risk factors for osteopenia because of the high incidence of unrecognized osteopenia and low fracture rate when the test is positive.
The most common treatment for osteopenia is multivitamin therapy. Regular physical therapy is useful and can be combined with aerobic exercise to improve bone turnover. Exercise is a safe alternative therapy and is recommended, for example, in patients with knee pain and knee osteoarthritis. For osteoporosis prevention, osteocalcin can be used.
Patients with osteopenia on the whole are unlikely to have fracture. A more careful definition of osteopenia which identifies the frail elderly may identify patients who would benefit from prevention and intervention programs.
Despite the risks it presents, DHEA was a safe and effective treatment in this population. The side effects were well tolerated, and the potential for a risk of osteopenia or osteoporosis in menorrhagia is an interesting observation, and could be a significant clinical issue.
A nutritional intervention delivered through nutritional supplements containing DHEA improved BMD but did not improve quality of life in women with low levels of BMD.
In patients with advanced stages of GCXD deficiency that resulted in delayed tooth eruption, an individual treatment of dental extractions in combination with a treatment of DHEA may be beneficial. However, further well-designed clinical studies are needed.
Dhea can be safely and effectively prescribed to patients with osteoporosis who are at high risk for developing osteoporotic fractures and are currently on stable or intermittent exogenous estrogen therapy. Dhea should be part of a comprehensive treatment protocol for osteoporosis including calcium, bisphosphonates, and adequate hormone therapy.
Dhea and its derivatives have shown significant effects in clinical trials. Dhea and its derivatives have been shown to be well tolerated and safe for use in clinical studies.