Dr. Khosla, a professor of medicine at the Mayo Clinic in Rochester, Minn., suggested in an interview that before turning to drugs, people with osteopenia could try to prevent further bone loss with regular weight-bearing and strength-training exercise, adequate intake of calcium and vitamin D, not smoking and limiting alcohol consumption to one drink a day.
The exceptions — those most likely to benefit from drug treatment even if they do not yet have osteoporosis — include people who already have had a low-trauma fracture and those with a bone density level approaching osteoporosis who also have other risk factors, like early menopause, a family history of osteoporosis, the use of steroid drugs (prednisone and others that increase bone loss), extreme thinness, a digestive problem that limits calcium absorption or advanced age.
“Age is itself a major risk factor for fracture,” said Dr. Ethel Siris, director of the osteoporosis clinic at Columbia University Medical Center in New York. Even at the same bone density, a woman of 75 or older is more likely to experience a fall and fracture than a woman of 55.
Dr. Siris explained that with age, changes in the architecture of bones diminish their strength, which can be countered by bisphosphonates. Current thinking in the field, she said, is to place women at risk of fracture on a drug like Fosamax for five years and then perhaps take a one-year drug holiday. For two other bisphosphonates, Actonel and Boniva, she suggests a drug holiday of 6 to 12 months after seven years of treatment.