What to know about osteopenia
While osteopenia does not often cause symptoms, it may increase the risk of other, more harmful bone conditions, such as osteoporosis. However, a person can take steps to protect their bones and reduce the risk of osteoporosis.
Throughout life, the body reabsorbs or breaks down bone cells. However, other specialized cells use calcium to build new bone. The bones, therefore, generally retain their mass and strength.
As a person ages, the body reabsorbs the bone cells faster than it can replace them, which leads to a decrease in bone density.
In this article, we explain the causes of low bone density, as well as ways to boost bone density and prevent osteoporosis.
Osteopenia occurs in about half of all people over the age of 50 years in the United States.
According to Harvard Medical School, around half of all people over the age of 50 years in the United States have osteopenia.
Women, especially after menopause, have a much higher risk than men of developing the condition. However, one third of white and Asian men over 50 years of age have osteopenia.
Additional risk factors include:
- Diet: A person who has a diet that is low in vitamin D and calcium may be more likely to develop osteopenia. Excessive alcohol use can also decrease the bones' ability to absorb calcium.
- Smoking: Calcium helps a person build strong bones. Smoking interferes with the amount of calcium the bones can absorb and may speed up bone density loss.
- Some medications: Certain medications 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 osteopenia.
The bones contain minerals including phosphate and calcium that make them strong and dense. The weaker the bones become, the more easily they break.
Due to a lack of symptoms, most people do not know they have osteopenia until they have a bone density test.
The most common bone density test that doctors use is called a dual-energy X-ray absorptiometry (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.
Doctors use a T-score to report the test results. The T-score result compares the individual's bone mass with the expected bone mass for their age.
For example, a normal T-score is above -1.0. A doctor would diagnose osteopenia if a person has a T-score between -0.1 and -2.5.
Individual recommendations on when to undergo testing for osteopenia may vary based on risk factors. Typically, doctors recommend that all women over 65 years of age should have a bone density test.
Also, women who are under 65 years of age but have reached menopause and have an additional risk factor for developing osteopenia, such as regular tobacco intake, 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:
Leafy greens are a plentiful source of calcium.
Nutritional recommendations may include eating more foods that increase bone strength.
For example, calcium and vitamin D can help build bone strength.
Foods high in calcium include:
- leafy green vegetables
Plentiful sources of vitamin D include:
- beef liver
- oily or fatty fish
- fortified cereal
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 push-ups and squats
- lifting weights
- using weight machines
Weight-bearing exercises include activities, such as dancing, stair climbing, and walking. Tai chi or yoga can help preserve flexibility
Balancing exercises might also help prevent falls as a person gets older, decreasing the risk of breaks.
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 people whose bone density has progresssed to the level of osteoporosis, doctors may prescribe medication, such as hormone replacement therapy (HRT).
Osteopenia vs. osteoporosis
People with osteoporosis have even lower bone density than those with osteopenia.
Osteoporosis leaves bones fragile, which can mean that even minor falls may cause bone fractures. It can also lead to stooped posture, loss of height, and a collapsed vertebra.
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.
Avoiding or quitting smoking can reduce the risk of osteopenia.
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.
- Reducing phosphate-containing soda: Certain types of soda, such as cola, contain phosphate acid. This can decrease levels of calcium in the bones. 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. Added table salt is not the only source of excess sodium. Fast food, canned meat, ready meals, and processed food are often high in salt.
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 a person needs may vary based on age, gender, and other underlying risk factors for osteopenia.
Osteopenia isn’t quite osteoporosis, but will it still increase my risk of a bone fracture?
Osteopenia and osteoporosis can exist for some time before a diagnosis is made. Osteopenia definitely increases your risk of developing osteoporosis.
Osteoporosis and aging and/or trauma such as falls increase the risk of fractures.Brenda B. Spriggs, M.D. FACP Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.