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Should a diagnosis of osteopenia trigger clinical action?

Osteopenia is far more widespread than osteoporosis, its incidence in the older age-groups being roughly three times that of osteoporosis. Furthermore, almost one-sixth of the young-adult population are--by definition--osteopenic (< 1% have osteoporosis). The National Osteoporosis Foundation guidelines suggest intervention at T-scores of -2.0 or lower; however, risk factors are built into various sets of guidelines, such that intervention may be desirable at T-scores of -1.0. The risk of fracture is, in fact, greater at lower bone mineral densities (BMD) throughout the entire range of BMD values. Thus, osteopenia is a management issue. This article considers the risks of fracture in terms of BMD and other factors, and recommends action that answers the prevention needs of the individual patient.