What You Need to Know About Osteopenia

Osteopenia is defined as low bone mineral density caused by a decrease in bone mass. Osteopenia is often a precursor to osteoporosis, a common condition that results in brittle bones that are more prone to fracture under stress. The two medical terms are sometimes confused, and it's important to know the difference and how each is related to arthritis.

The biggest difference between osteopenia and osteoporosis is the amount of bone mineral density loss as determined by dual-energy X-ray absorptiometry (DXA) scans. Osteoporosis is considered to be a disease, while osteopenia is considered as a marker for risk of fractures and predisposition to osteoporosis.

Osteopenia Explained

Osteopenia results when the formation of new bone does not occur at a rate that can offset normal bone loss. Bone density scans have made this easier to measure. Prior to bone density testing, radiologists used the term osteopenia to describe bones that seemed more translucent than normal on X-ray, and the term osteoporosis described the occurrence of vertebral fracture.

Bone mineral densitometry, or bone density scans (DXA is the most commonly used), changed those definitions.

The T score is your bone density compared with what is normally expected in a healthy young adult of your sex. A T score above -1 is normal. Using this criteria, 33.6 million Americans have osteopenia. The significance of that statistic is similar to identifying who is pre-hypertensive or those who have borderline cholesterol. In other words, identifying a group that is at risk for developing a disease.

Other Risk Factors for Fracture

Osteopenia is only one risk factor for fracture. Other risk factors include:

• Previous fracture
• Age (risk of fracture increases with age)
• Smoking (weakens bones)
• Drinking more than two alcoholic drinks per day (increases risk of hip fracture)
• Low body weight (increases risk of hip fracture)
• Race and gender (white women have two or three times risk compared to men or black and Hispanic women)
• Having a parent who had a hip fracture
• Sedentary lifestyle
• Inadequate calcium and vitamin D intake
• Conditions that increase the risk of falling such as poor vision, poor footwear, medical conditions that affect balance, use of sedative medications, or a history of falls
• Taking certain medications, including corticosteroids can result in glucocorticoid-induced osteoporosis
• Having certain medical conditions, such as rheumatoid arthritis or other rheumatic diseases can cause secondary osteoporosis
  

Treatment

Treatment for osteopenia primarily focuses on preventing the condition from progressing to osteoporosis, as well as reducing the risk of fractures.

Lifestyle changes can slow the progression of bone loss and decrease the risk of fractures. Lifestyle changes that can help prevent fractures include:

• Consuming enough vitamin D and calcium, ideally from whole food sources, but if necessary you may need to take supplements to reach necessary levels
• Maintaining a healthy weight
• Participating regularly in strength training or weightlifting
• Participating regularly in weight-bearing exercise (walking, running, hiking, and tennis are examples of weight-bearing exercise, while swimming is non-weight-bearing),
• Quitting smoking
• Avoiding alcohol and caffeine
  

It's important to remember that T scores alone cannot predict which patients with osteopenia will have fractures and which patients will not. Assessing all of the risk factors is the best way to decide whether treatment with osteoporosis medications is indicated.

In patients with osteopenia but no history of fracture, healthcare professionals will use a calculator to develop a metric called FRAX that helps decide who might benefit from prescription medication to decrease fracture risk. In patients with a 3% risk of a hip fracture over 10 years or a 20% chance of fracture elsewhere, prescription medication may be recommended.

Prescription medications used to treat osteopenia and osteoporosis include:

• Calcitonin
• Raloxifene
• Bisphosphonates
• Denosumab
• Parathyroid hormone

Summary

Osteopenia refers to having low bone density that is not low enough to be osteoporosis. Low bone density can significantly increase your risk of fractures.

Treatment for osteopenia generally focuses on lifestyle modifications that can help slow down additional bone loss, such as getting adequate calcium and vitamin D in your diet (or though supplements), participating regularly in weight-bearing exercise, and avoiding alcohol and smoking. Depending on the extent of your bone loss, your healthcare provider may recommend osteoporosis medications.