Osteopenia is a loss of bone density, which measures the mineral content in bones. When the mineral content in bones decreases, the bones become weaker, and the chance of breaking a bone increases. People diagnosed with osteopenia have a lower bone density than the average person of the same age, but osteopenia is not considered a disease. When bone density continues to decrease past a certain point, it becomes a disease called osteoporosis, leading to fractures, stooped posture, and loss of height. Not everyone with osteopenia develops osteoporosis, but the risk of developing osteoporosis increases if you are diagnosed with osteopenia. Osteopenia does not typically cause symptoms since losing bone density does not cause pain.
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Causes and Risk Factors
The risk for osteopenia increases with age. Bone mass peaks at age 35 and then starts to decline gradually. This means that bone density also decreases as you get older.
About half of Americans older than age 50 get osteopenia (1). Those with the following characteristics also have a higher risk of developing osteopenia:
- Female sex: women lose bone more quickly after menopause due to hormonal changes
- A family history of low bone density
- Age greater than 50
- Menopause, especially before age 45 and if ovaries are removed
- Lack of physical exercise
- Poor nutrition, especially calcium and vitamin D deficiency
- Unhealthy lifestyle choices such as smoking and drinking too much alcohol or caffeine
- Long-term use of certain medications such as prednisone or phenytoin (2)
- Stomach-related issues, such as celiac, which affects absorption of nutrients
- Certain other conditions such as anorexia, Cushing’s syndrome, thyroid conditions, and inflammatory arthritis
Summary: There are many risk factors for osteopenia including sex, age, and genetics. Some of these risk factors can be modified including a sedentary lifestyle, smoking, excessive drinking, and poor nutrition.
It is recommended to start getting screened for low bone density for women aged 65 and older or postmenopausal. For those younger than 65, including males, if you have one or more risk factors or have broken a bone from performing a normal activity, it is recommended that you get tested for low bone mineral density. Certain populations may also need to get their bone density tested more often due to a higher prevalence of low bone density. These populations include white and Asian women and men (3).
The diagnosis of osteopenia starts with a medical review and physical examination from your doctor. The first thing your doctor will do is take your medical history with special attention to any history of fractures, lifestyle habits including diet, exercise, smoking, and alcohol use, family history, menstrual cycle history, medications, and any current or past medical conditions. There likely will not be any findings during the physical examination, but your doctor will be looking for any changes in height and weight, posture, balance, and muscle strength that would indicate more severe bone density loss classified as osteoporosis.
The most common test ordered for diagnosing osteopenia is the dual-energy x-ray absorptiometry (DXA) which measures bone density in certain areas of the body that are prone to fracture from low bone density. The most commonly tested bones are the spine, hip, and forearm. This test uses low levels of x-rays as it moves a scanner over your body while you lay on a cushioned table. It is a quick and painless test.
The doctor will compare the results of your bone mineral density from the DXA scan to the average bone density of young, healthy people and to the average bone density of people of the same age, sex, and race. If your bone density is below a certain level you will be diagnosed with osteopenia.
The DXA scan can also be used to evaluate changes in bone density in response to treatments to evaluate how well the treatments are working.
Summary: The diagnosis of osteopenia involves a medical history review, physical examination, and bone density scan. The results of your bone density scan will be compared to age and gender-matched controls in order to diagnose the degree of bone loss.
The main goal of treatment for osteopenia is to keep bone density loss from progressing into osteoporosis. Osteopenia is usually treated with diet and exercise modifications since the risk of breaking a bone with osteopenia is low. Doctors will not start prescribing medications unless the bone mineral density is close to the osteoporosis level. Supplements such as calcium and vitamin D might be used for osteopenia.
The diet for osteopenia involves increasing the intake of calcium and vitamin D. The goal is to get 1,200 milligrams of calcium a day and 800 international units of vitamin D (4). One of the best sources of calcium and vitamin D are dairy products such as milk, yogurt, and cheese. Other types of food are fortified with calcium and vitamin D such as orange juice, bread, and cereals. Foods naturally high in calcium include dried beans, broccoli, wild freshwater salmon, and spinach.
Weight-bearing exercises such as walking, jumping, and running can strengthen your bones and increase your bone density. It is recommended to get 30 minutes of weight-bearing exercise on most days to increase bone density in those with osteopenia (5). Weight-bearing exercises are those in which your feet are on the ground. Exercise such as swimming and biking are good to increase cardiovascular health, but they do not build strength in bones.
Strength training is also effective at increasing bone density. Exercise should target muscles surrounding the specific bones that have tested low in bone density. For example, if you have been diagnosed with osteopenia in the hip, exercises should target the hip flexors and gluteals to increase the bone density of the hip.
Lifestyle modifications are important to prevent and treat low bone density. Avoiding smoking, excessive alcohol and caffeine consumption, and a sedentary lifestyle can help to prevent bone loss (6). Making sure you eat a healthy diet with enough calcium and vitamin D is also important for healthy bones. Getting enough exposure to the sun can also help the body absorb vitamin D.
Bone loss accelerates after menopause due to hormonal changes and the effects on bone density. For women, hormone therapy within the first 10 years after a final menstrual period has been shown to prevent bone loss and fractures. Hormone therapy is approved by the FDA just for the purpose of preventing bone loss.
Summary: Treatment for osteopenia includes getting enough calcium and vitamin D in your diet, weight-bearing exercise, avoiding smoking and excessive drinking, and hormone therapy.
Osteopenia is a loss of bone mineral density that weakens bone. People with osteopenia have lower bone density than normal, though it is not progressed enough to be considered osteoporosis. Osteopenia is more common in people older than 50, especially women. Bone density naturally declines with age, though certain risk factors such as smoking and a sedentary lifestyle can accelerate that decline. Treatment for osteopenia includes diet, exercise, calcium and vitamin D supplements, and hormone therapy. If you have risk factors for osteopenia speak with your doctor today to get tested and avoid further bone density loss!