Dr Louise Kuegler and Professor Ian Reid explore osteopenia—what it means, why it matters, and how it fits into fracture prevention. Drawing on the latest evidence, including Prof Ian Reid’s and Prof Mark Bolland's work, we discuss diagnosis, lifestyle strategies, treatment thresholds, and patient-centred approaches to protect bone health and prevent future fractures. An update for Zolendronate use is also discussed especially in the context of osteopenia.

In this episode we cover:

• Definition of osteopenia and its prevalence
• Risk factors and the role of exercise in bone health
• Assessing fracture risk
• Management strategies for osteopenia
• The importance and role of Menopause Hormone Therapy
• Recent advances in Zolendronate's role in Osteopenia and Osteoporosis
• Addressing osteopenia in men

Practical clinical pearls:

1. Aim for a BMI >20 to protect long-term bone health. Educate adolescents and young adult women that being underweight increases lifetime fracture risk.
2. Screen by fracture risk, not osteoporosis alone. Start with a risk calculator such as FRAX or Garvan; use DEXA only to refine risk when the calculated risk is moderate or uncertain.
3. Zoledronate is effective across age groups and bone density ranges. Evidence supports use both preventively in women in their 50s and therapeutically in women ≥65, including those who are osteopenic. Dosing frequency should follow study protocols (e.g., every 18 months in older women; every 5–10 years in preventive regimens).
4. Vitamin D has a role in those at risk of deficiency. Particularly useful for people in rest homes, those with dark skin, or those living in low-sunlight regions (e.g., South Island).
5. Avoid calcium supplements—prioritise dietary sources. Supplements offer minimal benefit for bone density or fracture prevention and carry risks (kidney stones, constipation, potential cardiovascular effects). A balanced diet that maintains a healthy BMI (>20) is preferred.

Resources:

Reid, Ian R, and Michael R McClung. “Osteopenia: A Key Target for Fracture Prevention.” The lancet. Diabetes & endocrinology 12.11 (2024): 856–864. Web.

 Reid, Ian R, and Michael R McClung. “Osteopenia: A Key Target for Fracture Prevention.” The lancet. Diabetes & endocrinology 12.11 (2024): 856–864. Web.

 Bolland, Mark J et al. “Fracture Prevention with Infrequent Zoledronate in Women 50 to 60 Years of Age.” The New England journal of medicine 392.3 (2025): 239–248. Web.

 https://osteoporosis.org.nz/wp-content/uploads/2024/09/ONZ-2017-Guidance-for-New-Zealand.pdf

Email me:

thespecialistgp@outlook.co.nz

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