Osteopenia - sorting out the confusion

Abstract

Osteoporosis is a bone disorder characterised by low bone mass and an increase in bone fragility and susceptibility to fracture. Diagnostic categories of osteoporosis and osteopenia (a less severe form of osteoporosis) have been defined on the basis of bone mineral density measurements (BMD). The relation between BMD and fracture risk is a continuum; the lower the BMD the greater the risk. Only 20% to 30% of women and men with fragility fractures have osteoporosis. A much larger number of those with fragility fractures have osteopenia. The risk of a fragility fracture depends on many factors in addition to BMD including age and propensity to falls. The assessment of fracture risk should be based on clinical risk factors combined with BMD measurements rather than on a fixed level of BMD and expressed as the absolute risk of fracture. With increasing fracture risk dietary supplements of calcium and vitamin D, exercise and measures to prevent falls are of increasing importance. Pharmacological therapy is indicated in those assessed to be at high fracture risk. A tool for the 5 and 10 year assessment of the absolute fracture risk based on clinical risk factors together with BMD is being developed by the World Health Organization. This tool should enable appropriate treatment to be targeted to women and men at increased fracture risk and the term osteopenia to be dropped.

Keywords: osteoporosis, osteopenia, fracture risk, diagnosis, treatment

Obstetrics and Gynaecology Forum Vol. 16(4) 2006: 105-111