Osteopenia: To Treat or Not To Treat?
Authors: Michael R. McClung
Journal: Annals of Internal Medicine (2005)

Editorials3 May 2005Osteopenia: To Treat or Not To Treat?Michael R. McClung, MDMichael R. McClung, MDFrom Providence Portland Medical Center, Oregon Osteoporosis Center, Portland, OR 97213.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-142-9-200505030-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The availability of an accepted and widely available diagnostic test and a set of effective treatment options for osteoporosis has challenged clinicians in deciding which patients should be treated. Once diagnosed when older women experienced a fracture of the spine or hip, osteoporosis is now recognized as a disorder of impaired bone strength that predisposes to fracture (1). The diagnosis of osteoporosis in postmenopausal women is now based solely on bone mineral density (BMD) values (T-score ≤ −2.5), according to the World Health Organization (WHO) criteria (2). In postmenopausal women with previous vertebral fractures or with BMD values consistent with ...References1. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001;285:785-95. [PMID: 11176917] CrossrefMedlineGoogle Scholar2. World Health Organization. Assessment of Fracture Risk and Its Application to Screening for Postmenopausal Osteoporosis. Technical Report Series no. 843. Geneva: World Health Organization; 1994. Google Scholar3. Delmas PD. Treatment of postmenopausal osteoporosis. Lancet. 2002;359:2018-26. [PMID: 12076571] CrossrefMedlineGoogle Scholar4. Iglesias CP, Torgerson DJ, Bearne A, Bose U. The cost utility of bisphosphonate treatment in established osteoporosis. QJM. 2002;95:305-11. [PMID: 11978902] CrossrefMedlineGoogle Scholar5. Johnell O, Jönsson B, Jönsson L, Black D. Cost effectiveness of alendronate (fosamax) for the treatment of osteoporosis and prevention of fractures. Pharmacoeconomics. 2003;21:305-14. [PMID: 12627984] CrossrefMedlineGoogle Scholar6. Kanis JA, Borgstrom F, Johnell O, Jonsson B. Cost-effectiveness of risedronate for the treatment of osteoporosis and prevention of fractures in postmenopausal women. Osteoporos Int. 2004;15:862-71. [PMID: 15175846] CrossrefMedlineGoogle Scholar7. Kanis JA, Borgström F, Johnell O, Oden A, Sykes D, Jönsson B. Cost-effectiveness of raloxifene in the UK: an economic evaluation based on the MORE study. Osteoporos Int. 2005;16:15-25. [PMID: 15672210] CrossrefMedlineGoogle Scholar8. McClung M, Clemmesen B, Daifotis A, Gilchrist NL, Eisman J, Weinstein RS, et al. Alendronate prevents postmenopausal bone loss in women without osteoporosis. A double-blind, randomized, controlled trial. Alendronate Osteoporosis Prevention Study Group. Ann Intern Med. 1998;128:253-61. [PMID: 9471927] LinkGoogle Scholar9. Effects of hormone therapy on bone mineral density: results from the postmenopausal estrogen/progestin interventions (PEPI) trial. The Writing Group for the PEPI. JAMA. 1996;276:1389-96. [PMID: 8892713] CrossrefMedlineGoogle Scholar10. Delmas PD, Bjarnason NH, Mitlak BH, Ravoux AC, Shah AS, Huster WJ, et al. Effects of raloxifene on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women. N Engl J Med. 1997;337:1641-7. [PMID: 9385122] CrossrefMedlineGoogle Scholar11. Dufresne TE, Chmielewski PA, Manhart MD, Johnson TD, Borah B. Risedronate preserves bone architecture in early postmenopausal women in 1 year as measured by three-dimensional microcomputed tomography. Calcif Tissue Int. 2003;73:423-32. [PMID: 12964065] CrossrefMedlineGoogle Scholar12. Management of postmenopausal osteoporosis: position statement of the North American Menopause Society. Menopause. 2002;9:84-101. [PMID: 11875327] MedlineGoogle Scholar13. Hodgson SF, Watts NB, Bilezikian JP, Clarke BL, Gray TK, Harris DW, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: 2001 edition, with selected updates for 2003. Endocr Pract. 2003;9:544-64. [PMID: 14715483] CrossrefMedlineGoogle Scholar14. National Osteoporosis Foundation. Physician's Guide to Prevention and Treatment of Osteoporosis. Washington DC: National Osteoporosis Foundation; 2003. Google Scholar15. Schousboe JT, Nyman JA, Kane RL, Ensrud KE. Cost-effectiveness of alendronate therapy for osteopenic postmenopausal women. Ann Intern Med. 2005;142:734-41. LinkGoogle Scholar16. Osteoporosis: review of the evidence for prevention, diagnosis and treatment and cost-effectiveness analysis. Introduction. Osteoporos Int. 1998;8 Suppl 4 S7-80. [PMID: 10197173] CrossrefMedlineGoogle Scholar17. Cummings SR, Black DM, Thompson DE, Applegate WB, Barrett-Connor E, Musliner TA, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA. 1998;280:2077-82. [PMID: 9875874] CrossrefMedlineGoogle Scholar18. Hamdy RC, Petak SM, Lenchik L. Which central dual X-ray absorptiometry skeletal sites and regions of interest should be used to determine the diagnosis of osteoporosis? J Clin Densitom. 2002;5 Suppl S11-8. [PMID: 12464707] CrossrefMedlineGoogle Scholar19. Kanis JA, Johnell O, Oden A, Dawson A, DeLaet C, Jonsson B. Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int. 2001;12:989-95. [PMID: 11846333] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Providence Portland Medical Center, Oregon Osteoporosis Center, Portland, OR 97213.Disclosures: Consultancies (Eli Lilly, Inc., Merck & Co., Procter & Gamble); Honoraria (Eli Lilly, Inc., Merck & Co., Procter & Gamble, Sanofi-Aventis); Grants received (Eli Lilly, Inc., Merck & Co., Procter & Gamble, Roche, Sanofi-Aventis).Corresponding Author: Michael R. McClung, MD, Oregon Osteoporosis Center, 5050 NE Hoyt, Suite 651, Portland, OR 97213; e-mail, [email protected]com. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCost-Effectiveness of Alendronate Therapy for Osteopenic Postmenopausal Women John T. Schousboe , John A. Nyman , Robert L. Kane , and Kristine E. 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