What is osteopenia?

Osteopenia is a chronic condition of the bones that develops when you lose bone mass due to which your bones become weaker. Low calcium levels in the body cause your bones to become brittle and lower your bone mineral density.

This condition tends to develop as you age and can last a lifetime. It leads to and increases your risk of osteoporosis if corrective measures are not taken. However, not everyone with osteopenia develops osteoporosis.

Because of weak and brittle bones, people with osteopenia are at a higher risk of developing fractures.

There are no symptoms, and a fracture itself and your advanced age may make your doctor suggest a bone density test, which can help to diagnose osteopenia.

How common is osteopenia?

Osteopenia is a fairly common condition and affects about 34 million Americans. It’s more commonly seen in:

  • All people above the age of 50 years due to the natural process of aging and loss of bone density
  • People with poor nutrition, which leads to weak bones due to calcium and vitamin D deficiency
  • Postmenopausal women due to reduced levels of the hormone estrogen

According to the World Health Organization, 30% of Caucasian postmenopausal women in the United States have osteoporosis, and 54% have osteopenia.

Symptoms of osteopenia

Most people with osteopenia do not exhibit any symptoms until it progresses to osteoporosis. There is no bone pain and because there are no symptoms it is not detected unless a person undergoes a bone density test. A person with osteopenia will experience pain when a bone is broken (fractured).

However, some people may develop symptoms of calcium deficiency, which include:

  • confusion or loss of memory
  • numbness and tingling in the hands, feet, and face
  • muscle cramps
  • weak and brittle nails
  • fracture of the bones even with mild trauma can occur but this is more common in osteoporosis

What causes osteopenia?

Bones are made of living tissue, which is constantly being broken down and replaced by new tissue.

When you’re young, new bone grows faster than your body breaks down old bone. This contributes to strong bones with high bone mass. Bone density is maximum between the ages of 25 and 30 in most people.

After the age of 35 years, bone tissue breaks down faster than it is being built and replaced, leading to a decrease in bone mass and bone density.

Even in normal conditions in a healthy person, bone density decreases by less than 1 percent per year throughout life. It is when you lose more, that you become susceptible to developing osteopenia.

Though there is no single cause for osteopenia, there are several risk factors: some you can control such as lifestyle, including dietary changes and the use of certain drugs, and some you cannot control such as loss of bone mass due to advancing age.

Your bone density score will help to identify this condition. If your bone density score is lower than normal — between -1 and -2.5 — you have osteopenia. If your score is lower than -2.5, you may be diagnosed with osteoporosis, which is more serious.

Women are more likely than men to develop osteopenia. This is due to several factors. Women generally have a lower bone mass. They also absorb less calcium than men and tend to live longer. Additionally, hormonal changes after menopause make them more susceptible.

After menopause, their rate of bone loss speeds up as the estrogen hormone levels fall. The ovaries produce estrogen, and therefore, faster bone loss will occur in a woman whose ovaries have been removed by surgery.

Risk factors

Risk factors that are fixed and you cannot control:

  • Age: Bone density starts naturally decreasing after the age of 35 years in both men and women.
  • Ethnicity: If you are European or Asian, you harbor a higher risk.
  • Sex: Women are at higher risk, especially those with early menopause.
  • Family history: Some families have a low bone mass. Members of such families have an increased risk.

Risk factors that you can control:

  • Smoking
  • Drinking alcohol in excess
  • Sedentary lifestyle without exercises particularly weight-bearing or resistance exercises
  • Insufficient caloric intake. If your calorie intake is insufficient and you eat only 800 to 900 calories a day for about six months, you are making your bones weak and increasing your risk of osteopenia.
  • A low-nutrient diet lacking in calcium and Vitamin D is another important risk factor.

Some diseases that increase your risk include:

  • Celiac disease, which results in poor absorption of calcium and vitamin D
  • Hyperthyroidism with high levels of thyroid hormones causes rapid loss of bone. This process of increased bone loss over time causes osteopenia. Hyperthyroidism also slows your body’s and your bone’s metabolism.
  • Anorexia nervosa, which causes a poor intake of calories, calcium, vitamin D, and other nutrients

Some medications due to prolonged use can increase your risk of osteopenia

  • Steroids
  • Anticonvulsants

How is osteopenia diagnosed?

To diagnose and confirm osteopenia, your doctor will order a bone density test. This test measures bone mass and bone strength.

A dual-energy X-ray absorptiometry (DEXA or DXA) measures the density and strength of your bones. It measures bone density in your hips, spine, and wrist, which are the most commonly fractured bones.

The result of the test can diagnose and tell if you have osteopenia or osteoporosis, or if your bones are normal.

  • Osteopenia T- score: A T-score between -1 and -2.5 tells you that you have osteopenia.
  • Osteoporosis T- score: T-score lower than -2.5 is diagnosed as osteoporosis.

Doctors usually advise that all women over 65 years old should undergo a bone density test. Women under 65 years old can be tested if they have any risk factors described above.

Diet plan for osteopenia

As part of treating osteopenia, your doctor will suggest improvements in your diet to increase your intake of calcium and vitamin D.

  • Calcium. Good sources of dietary calcium include nonfat and low-fat dairy products, such as yogurt, cheese, milk, dried beans, spinach, broccoli and salmon, and sardines.
  • Vitamin D. Some foods such as orange juice, bread, and dry cereals, come fortified with calcium or vitamin D, or both. Foods that will give your body vitamin D include fish such as salmon, tuna, mackerel, beef liver, cheese, and egg yolks. Expose your skin to the sunlight every day for 15 minutes. This will be the best source of vitamin D for your body.
  • Cut back on salt and caffeine. Too much consumption of both these may increase the loss of calcium and bone. They are associated with a high risk of developing osteopenia.

Studies show that good consumption of fruits and vegetables is associated with improved bone density. Your doctor may also suggest vitamin D and/or calcium supplements if he feels you need them.

The osteoporosis diet is along the same lines and tells you also what foods to avoid in osteopenia.

Osteopenia treatment

There’s no cure for osteopenia and it cannot be reversed. Treatment and lifestyle improvements help to preserve bone density as much as possible. They involve simple strategies to keep your bones healthy and strong and prevent the progression to osteoporosis.

The first advice your doctor will give you to treat osteopenia is to make changes to your lifestyle. He will advise you to increase your physical activity.

  • Exercises for osteopenia. Weight-bearing exercises are advised because they help strengthen your bones, build muscle strength and improve your balance. All this helps prevent fractures. Examples of weight-bearing exercises include walking, jogging, and climbing steps. These exercises are the same as those prescribed for osteoporosis
  • Don’t smoke and drink less. If you smoke, quit smoking. Smoking has been strongly linked to increased bone loss. If you drink, stay within safe drinking limits. Heavy alcohol consumption decreases bone density and weakens the bones.
  • Medications. The following prescription medications are treatment options for osteopenia as well as osteoporosis. They are well described in the post on osteoporosis treatment.
      • Bisphosphonates
      • Calcitonin
      • Teriparatide (Forteo)
      • Denosumab (Prolia)
      • Hormone replacement therapy with estrogen and progesterone in postmenopausal women
      • Raloxifene (Evista)

Can osteopenia be prevented or avoided?

You can’t always avoid osteopenia. No matter what you do, bone mass decreases over time. But, steps taken early in life can help to a great extent to slow down or minimize bone loss.

There are some things you can do to lower your risk:

Long-term use of certain medicines also can increase your risk. If you’re taking corticosteroids and anticonvulsants, talk to your doctor who will suggest ways to go around it.