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Osteopenia refers to bone density that is lower than normal peak density but not low enough to be classified as
osteoporosis. Bone density is a measurement of
how dense and strong the bones
are. If your bone density is low compared to normal peak density, you are said to have
osteopenia. Having osteopenia means there is a greater
risk that, as time passes, you may develop bone density that is very low compared to
normal, known as osteoporosis.
Bones naturally become thinner as people grow
older because, beginning in middle age, existing bone cells are reabsorbed by
the body faster than new bone is made. As this occurs, the bones lose minerals,
heaviness (mass), and structure, making them weaker and increasing their risk
of breaking. All people begin losing bone mass after they reach peak bone density at
about 30 years of age. The thicker your bones are at about age 30, the longer
it takes to develop osteopenia or osteoporosis.
Some people who
have osteopenia may not have bone loss. They may just naturally have a lower
bone density. Osteopenia may also be the result of a one or more other
conditions, disease processes, or treatments. Women are far more likely to
develop osteopenia and osteoporosis than men. This is because women have a
lower peak bone density and because the loss of bone mass speeds up as hormonal changes
take place at the time of menopause. In both men and women, the following
things can contribute to osteopenia:
Having a family history of osteoporosis, being thin, being
white or Asian, getting limited physical activity, smoking, regularly drinking
cola drinks, and drinking excessive amounts of alcohol also increase the risk
of osteopenia and, eventually, osteoporosis.
Osteopenia has no symptoms. You notice no
pain or change as the bone becomes thinner, although the risk of breaking a
bone increases as the bone becomes less dense.
Osteopenia is diagnosed with a
bone density test, usually done to see whether you have
osteoporosis. The most accurate test of bone density is dual-energy X-ray absorptiometry
(DXA), although there are other methods. DXA is a form of X-ray that can
detect as little as 2% of bone loss per year. A standard X-ray is not useful in
diagnosing osteopenia, because it is not sensitive enough to detect small
amounts of bone loss or minor changes in bone density. See the topic
Osteoporosis for more information on bone density testing.
United States Preventive Services Task Force
(USPSTF) recommends that all women age 65 and older routinely have a
bone density test to screen for osteoporosis.
If you are at increased risk for fractures caused by osteoporosis, routine
screening should begin sooner.1 USPSTF recommends that you and your doctor check your fracture risk using a tool such as FRAX to help decide whether you should be screened for osteoporosis. Talk to your doctor about your risk factors and when to start bone density screening.
The FRAX tool was developed by the World Health Organization to help predict your risk of having a fracture related to osteoporosis in the next 10 years. You can use this tool. Go to the website at www.sheffield.ac.uk/FRAX, and click on Calculation Tool. If you have had a bone density test on your hip, you can type in your score. If you have not had that test, you can leave the score blank.
Things that increase risk include:
Information for men. Experts suggest that older men talk to their doctors about osteoporosis and, if they are at risk, have bone density tests done.2
Many men don't think they are at risk for osteopenia or osteoporosis, since
these are commonly considered to be conditions of older women. Because men have
a higher peak bone density than women at middle age, osteopenia and
osteoporosis tend to happen at an older age in men. But aside from the hormonal
change in women as they go through menopause, the things that put people at risk for osteopenia
are true for men as well as for women. Men are also at risk if they have low
levels of the hormone testosterone. Talk with your doctor if any risk factors
apply to you.
Osteopenia is treated by taking steps to keep it from progressing to
osteoporosis and, for a few people, by taking medicine. Lifestyle changes can
help reduce the bone loss that leads to osteopenia and osteoporosis.
What you eat is very important to bone development. Calcium is the most critical
mineral for bone mass. Your best sources of calcium are milk and other dairy
products, green vegetables, and calcium-enriched products.
doctor may also want you to take a calcium supplement, often combined with
vitamin D. Vitamin D helps your body absorb calcium and other minerals. It is
found in eggs, salmon, sardines, swordfish, and some fish oils. It is added to
milk and can be taken in calcium and vitamin supplements. In addition to what
you take in from food, your body makes vitamin D in response to
Exercise is important for having strong bones,
because bone forms in response to stress. Weight-bearing exercises such as
walking, hiking, and dancing are all good choices. Adding exercise with light
weights or elastic bands can help the bones in the upper body. Talk to your
doctor or a physical therapist about starting an exercise program.
In addition to diet and exercise, quitting smoking and avoiding excessive
use of alcohol and cola will also reduce your risk of bone loss.
There are medicines for treating bone thinning. But these are more
commonly used if you have progressed past osteopenia to the more serious
condition of osteoporosis. Medicines that may be used for osteopenia include
bisphosphonates, raloxifene, and hormone replacement. For more information on
these medicines, see the topic Osteoporosis.
Whether you will tend to
develop osteopenia is, in part, already determined. Things like whether you
have any family members who have had osteoporosis or osteopenia, whether you
have chronic asthma that requires you to take steroids, and how much calcium
and vitamin D you got while you were growing up are beyond your control now.
But if you are a young adult or if you are raising children, there are things
you can do to help develop strong bones and help slow down osteopenia and
Your bones don't reach their greatest
density until you are about 30 years old. So for children and people younger
than 30, anything that helps increase bone density will have long-term
benefits. To maximize bone density, make sure you get plenty of calcium and
vitamin D through your diet and by spending a little time in the sun, get
weight-bearing exercise on a regular basis, don't smoke, and avoid cola and
excessive alcohol. If you have children, teach them to eat healthy, get regular
exercise, and avoid smoking and alcohol. Also, get them to play a little in the
sunshine to help their bodies make more vitamin D. Talk
with your doctor about how much and what sources of vitamin D are right for
If you're older than 30, it's still not too late to
make these lifestyle changes. A balanced diet and regular exercise will help
slow the loss of bone density, delay osteopenia, and delay or prevent
U.S. Preventive Services Task Force (2011). Screening for Osteoporosis: Recommendation Statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf10/osteoporosis/osteors.htm.
Qaseem A, et al. (2008). Screening for osteoporosis in men: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 148(9): 680–684. Also available online: http://www.acponline.org/clinical_information/guidelines/guidelines.
Other Works Consulted
Halar EM, Bell KR (2010). Physical inactivity: Physiological and functional impairments and their treatment. In WR Frontera, ed., DeLisa's Physical Medicine and Rehabilitation: Principles and Practice, 5th ed., vol. 2, pp. 1249–1272. Philadelphia: Lippincott Williams and Wilkins.
November 6, 2012
Kathleen Romito, MD - Family Medicine & Carla J. Herman, MD, MPH - Geriatric Medicine
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