To treat or not to treat osteopenia?

British investigators argue that many of the studies supporting drug treatment of osteopenia understate the side effects, overstate the benefits, involve potential conflicts of interest, and base efficacy claims on reductions in relative, rather than absolute, risk for fractures.

They cite one raloxifene trial that touts a 75% reduction in relative risk of fracture, which translates into only a 0.9% reduction in absolute risk. They also mention four studies, one each involving alendronate, raloxifene, risedronate, and strontium ranelate, that indicate anywhere from 0.9% to 8.6% absolute risk exists over 3 to 5 years in control patients. That means that anywhere from 133 to 270 women with preosteoporosis (women "at risk for being at risk") need to be treated with drugs for 3 years to prevent a single fracture in one of them.

The World Health Organization is currently developing an absolute fracture risk algorithm to assist practitioners with managing women categorized as having osteopenia. In the meantime, the practitioners remind us that the number 1 risk factor for fracture is falls, not low bone mineral density, and that we should work on preventing the former as much as we do the latter.