Osteopenia

Osteopenia is an early sign of bone weakness that is less severe than osteoporosis. The image on the left shows decreased bone density in osteoporosis. The image on the right shows normal bone density.

• Our skeleton is composed of bone that is necessary for our structure, design, and function, as well as the protection of internal organs.
• A weakening of bone can lead to fracture of bone, pain, and deformity.
• Osteopenia is an early sign of bone weakness that is less severe than osteoporosis.
• Osteopenia is treatable with exercise, lifestyle changes, dietary supplements, and medications.
• It is possible to prevent osteopenia.

The density of bone, a sign of the quality of the strength of bone, can easily be measured. The standard test for measuring the density of bone is a bone density test, either by CT scan of the lumbar spine (quantitative computed tomography or QCT) or, more commonly, by DEXA (dual energy X-ray absorption) bone density test. The bone density test provides a numerical rating of the density of the bones measured. Bones that are often tested in this manner include the lumbar spine, the femur bone of the hip, and the forearm bone. The numerical result of the bone density test is quantified as a "T score." The lower the T score, the lower the bone density. T scores greater than -1.0 are considered normal and indicate healthy bone. T scores between -1.0 and -2.5 indicate osteopenia. T scores lower than -2.5 indicate osteoporosis.

Decreased bone density characterizes osteopenia.

Risk factors for osteopenia include a family history of osteoporosis, previous low-impact bone fracture, smoking, rheumatoid arthritis, Asian descent, thin body habitus, corticosteroid (prednisone or prednisolone) usage, low estrogen in women, low testosterone in men, malabsorption conditions (such as celiac disease), and regular alcohol intake.

The difference between osteopenia and osteoporosis is a matter of severity of the loss of bone density. From a practical standpoint, this means that while people with osteopenia are at somewhat increased risk for bone fracture than normal, those with osteoporosis are at a much greater risk of fracturing bone than those with osteopenia. Accordingly, osteoporosis is typically treated much more aggressively than osteopenia.

Osteopenia is treated by general medicine physicians including general practitioners, internists, and family medicine doctors as well as endocrinologists, gynecologists, and rheumatologists.

Osteopenia usually causes no symptoms. That means that osteopenia is frequently not detected unless a person has a bone density test. When osteopenia does cause symptoms, there may be localized bone pain and weakness in an area of breakage of bone (bone fracture). Interestingly, sometimes even bone fracture can occur without causing pain.

Osteopenia can be suggested by findings on plain film X-ray testing. However, the standard test for measuring the density of bone and detecting osteopenia is a bone density test, either by CT scan of the lumbar spine (quantitative computed tomography or QCT) or, more commonly, by DEXA (dual energy X-ray absorption) bone density test. The abnormally low bone mineral density (BMD) that is indicated by these methods describes osteopenia.

The National Osteoporosis Foundation (NOF) recommends bone density testing be considered in the following groups:

• Women 65 years of age and older and men 70 years of age and older
• Postmenopausal women and men 50-69 years of age who are at risk for having osteoporosis
• Adults with a medical condition associated with bone loss, such as rheumatoid arthritis or malabsorption, or those who take medication that can lead to bone loss and lower bone density (such as prednisone, prednisolone, and phenytoin [Dilantin])
• Adults who have a fractured bone after 50 years of age
• Anyone considered for prescription medication treatment for either osteopenia or osteoporosis
• Anyone treated for osteoporosis to monitor treatment

A primary treatment for osteopenia is exercise. Exercise has two essential benefits, both by directly stimulating stronger bone and indirectly in fall prevention. Therefore, weight-bearing exercise and strengthening exercise is recommended. Lifestyle modifications are also crucial to optimal bone health and include smoking cessation as well as avoiding excessive alcohol.

Supplementation with calcium and vitamin D is also part of the treatment protocol. Optimal dosing of vitamin D can be assured by measuring vitamin D in blood testing.

The decision as to medication treatments for osteopenia is individualized based on underlying medical illness and history of bone health, as well as an assessment of risk factors described above. Not every person requires additional prescription medications for their osteopenia. The doctor will assess all of the factors above in deciding whether or not to recommend medications. Medications that are used to treat osteopenia include bisphosphonate medications, such as alendronate (Fosamax), ibandronate (Boniva), zoledronate (Reclast), and risedronate (Actonel), as well as raloxifene (Evista).

Yes. Exercise, both aerobic and strengthening, as well as calcium and vitamin D supplementation can be beneficial to bone in patients with osteopenia. Avoiding excessive alcohol and smoking cessation are additional home remedy solutions. These remedies should all be used, even in patients taking prescription medications for osteopenia.

One great choice: dark leafy greens such as bok choy, Chinese cabbage, kale, collard greens, and turnip greens. One cup of cooked turnip greens has about 200 milligrams of calcium.

The Institute of Medicine established the following guidelines for calcium and vitamin D dietary intake and supplementation:

Vitamin D

• 800 IU (international units) daily for women over the age of 71
• 600 IU daily for women in other age groups, men, and children
• 400 IU daily for infants under 12 months of age

Calcium

• 1,200 mg (milligrams) daily for adult women over the age of 50 and men 71 years and older: At least 1,200 mg is recommended, including diet and supplements. Calcium should be taken in divided doses, no more than 600 mg at once, to ensure optimal intestinal absorption.
• 1,000 mg daily for younger adult women (who are not breastfeeding or lactating) and adult men

People with celiac disease should avoid gluten, which will minimize the risk of malabsorption that can cause osteopenia.

The overall prognosis of osteopenia is very good with home remedy solutions and lifestyle changes. With medications, bone density can be stabilized so that fracture risk is minimized.

It's possible to prevent osteopenia by supplementation with calcium and vitamin D, as well as exercise, avoiding alcohol, not smoking, and minimizing the use of corticosteroid medications. Furthermore, for postmenopausal women, estrogens and progesterone can be used to prevent osteopenia.