This article explores the causes and treatments for osteopenia. It also looks at ways to prevent it.
As a person ages, bone density can naturally decrease. Osteopenia is characterized by extremely low bone density, regardless of age.
The bones contain minerals including phosphate and calcium that make them strong and dense. The weaker the bones, the easier they are to break.
Throughout a person's life bone cells are broken down or reabsorbed by the body. But other specialized cells use calcium to build new bone.
As a person ages, the body reabsorbs the bone cells faster than it can replace them, which leads to a decrease in bone density.
Osteopenia vs. osteoporosis
Osteopenia is sometimes confused with osteoporosis. Although both conditions are related to bone density, they are not the same thing.
Osteopenia involves below normal levels of bone density. Osteoporosis is considered more serious than osteopenia because the extent of the bone loss is more severe.
Osteoporosis leaves bones fragile, which can lead to bone fractures even from minor falls. It can also lead to stooped posture, loss of height, and a collapsed vertebra.
Both osteoporosis and osteopenia are very common.
According to the National Osteoporosis Foundation, about 54 million people in the United States have osteoporosis. Many more people are estimated to have osteopenia.
It is important to understand that people with osteopenia are at an increased risk of developing osteoporosis.
Risk factors for developing osteopenia
Bone density peaks when people reach about 30 years old and gradually declines as they age.
People over the age of 50 have an increased risk of developing osteopenia. Women, especially those who are post-menopausal, are also at a much higher risk than men of developing the condition.
Men do develop osteopenia and osteoporosis, but much less frequently than women.
According to the Osteoporosis and Related Bone Diseases National Resource Center, about 2 million men are affected by osteoporosis.
One reason osteopenia occurs much more commonly in women is that their bones tend to be smaller and thinner than men's bones.
Asian and Caucasian women also have a higher risk of osteoporosis and osteopenia than other ethnicities.
Additional risk factors for osteopenia have been identified, including:
- Diet: A person who has a diet low in vitamin D and calcium may be more likely to develop osteopenia. Excessive alcohol use can also decrease the bone's ability to absorb calcium.
- Smoking: Calcium helps build strong bones. Smoking interferes with the amount of calcium the bones absorb and may speed up bone loss.
- Some medications: Certain medication can accelerate bone loss, especially in those people who take it for extended periods. For example, some anti-seizure medications, cancer drugs, and steroids may lead to a decrease in bone density.
- Certain medical conditions: Having certain medical conditions, such as lupus, rheumatoid arthritis, and celiac disease also increases a person's risk of developing osteopenia.
X-rays are often used to diagnose osteopenia. Specifically, a dual-energy X-ray may be used.
Most people do not know they have osteopenia until they have a bone density test.
In fact, it is often considered a silent disease since symptoms are usually not present. That's why a bone density test is so important.
The most common bone density test used is called dual-energy X-ray absorptiometry or DEXA.
DEXA involves using a low-energy X-ray that assesses the level of calcium in the bones.
The National Osteoporosis Foundation suggests that the best places to perform the test are the hip or spine. Measurements from these areas are considered the best at predicting which people are at risk of fracture.
The test results are reported using a T-score. The T-score result is compared to a healthy person with normal bone mass.
For example, a normal T-score is above -1.0. Osteopenia is diagnosed with a T-score between -0.1 to -2.5.
Individual recommendations on when to get tested for osteopenia may vary based on risk factors. Typically, doctors recommend that all women over 65 have a bone density test.
Also, women who are under 65 but have reached menopause and have an additional risk factor for developing osteopenia should also consider having the test.
Treatment for osteopenia
Osteopenia can often progress to osteoporosis. Once a person has osteoporosis, their risk of fractures increases.
Treatment can help prevent the condition from progressing. Treatment may include the following:
Nutritional recommendations may include adding foods that increase bone strength.
For example, calcium and vitamin D help build bone strength.
Foods high in calcium include:
- leafy green vegetables
Good sources of vitamin D include:
- beef liver
- oily or fatty fish
- fortified cereal
Doctors may also suggest limiting certain foods and drinks that may increase the risk of bone loss.
Osteopenia can be managed and prevented with regular exercise.
Exercise is recommended to both prevent and treat osteopenia. Regular exercise can prevent further bone loss and may improve bone density.
An exercise program should include both muscle strengthening and weight-bearing exercises. Muscle strengthening exercises may include:
- body weight exercises, such as pushups and squats
- lifting weights or using weight machines
Weight-bearing exercises include activities, such as dancing, stair climbing, and walking.
Balancing exercises are also often recommended to help prevent falls as someone ages.
Doctors may not recommend medications until a person's condition progresses to osteoporosis.
If a person with osteopenia has already suffered a bone fracture, however, doctors may prescribe medication.
Medication may include a class of drugs called bisphosphonates that work by preventing bone reabsorption. For those whose condition has progressed to osteoporosis, doctors may prescribe medication, such as hormone replacement therapy.
Many of the strategies adopted for preventing osteopenia can be applied to treating the condition.
For example, regularly participating in weight-bearing exercise can decrease the risk of developing osteopenia.
Eating a well-balanced diet including foods high in calcium and vitamin D is also helpful in preventing bone loss.
Additional lifestyle changes that could prevent osteopenia include:
- Avoiding nicotine: Smoking and other forms of nicotine, such as chewing tobacco, nicotine gum, and patches, can affect how the body absorbs and maintains calcium, which can speed up bone loss. People who
- Reducing phosphate-containing soda: Certain types of soda, such as cola, contain phosphate acid, which can decrease calcium in the bones. Also, the caffeine in some soda can also affect bone density.
- Limiting salt use: Foods high in salt can cause the body to lose calcium and decrease bone density. Keep in mind; it's not just added table salt that increases the level of sodium in the body. Certain foods, such as fast food, canned meat, and frozen dinners are often high in salt.
- Taking nutritional supplements: People who do not get enough calcium and vitamin D in the foods they eat should ask their doctor about supplements. The amount of calcium recommended may vary based on age, gender, and other risks for osteopenia.