There is no convincing evidence that anti-osteoporotic therapy in patients with osteopenia alone reduces fracture risk. The 2008 Cochrane Reviews for three bisphosphonates (Alendronate, Etidronate, Risedronate) found no statistically significant reductions for primary prevention of fracture in postmenopausal women. Fracture risk is determined using either the Canadian Association of Radiologists and Osteoporosis Canada risk assessment tool (CAROC) or FRAX®, a World Health Organization fracture risk assessment tool. Both are available as online calculators of fracture risk. Given the lack of proven efficacy, widespread use of bisphosphonates in patients at low risk of fracture is not currently recommended.
Sources:
FRAX®. WHO fracture risk assessment tool [Internet]. 2011 Jun [cited 20177 May 5].
Osteoporosis Canada. Assessment of 10-year fracture risk – women and men [Internet]. 2010 [cited 2017 May 5].
Roux C. Osteopenia: Is it a problem?. Int J Clin Rheumtol. 2009 Dec;4(6):651-5.
Wells GA, et al. Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD001155. PMID: 18253985.
Wells GA, et al. Etidronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD003376. PMID: 18254018.
Wells G, et al. Risedronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD004523. PMID: 18254053.
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Patient Pamphlet: Treating Rheumatoid Arthritis: “Non-biologic” drugs are a better first choice
Patient Decision Aid: Mayo Clinic’s Bone Health Choice Decision Aid