Osteopenia

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Overview

What is osteopenia?

Osteopenia refers to bone mineral density (BMD) that is lower than normal peak BMD but not low enough to be classified as osteoporosis. Bone mineral density is a measurement of the level of minerals in the bones, which indicates how dense and strong they are. If your BMD is low compared to normal peak BMD, you are said to have osteopenia. Having osteopenia means there is a greater risk that, as time passes, you may develop BMD that is very low compared to normal, known as osteoporosis.

What causes osteopenia?

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 BMD 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 wide variety of 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 BMD 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 factors can all contribute to osteopenia:

• Eating disorders or metabolism problems that do not allow the body to take in and use enough vitamins and minerals
• Chemotherapy, or medications such as steroids used to treat a number of conditions, including asthma
• Exposure to radiation

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.

What are the symptoms of osteopenia?

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.

How is osteopenia diagnosed?

Osteopenia is diagnosed with a bone mineral density (BMD) test, usually done to see whether you have osteoporosis. The most accurate test of BMD is dual-energy X-ray absorptiometry (DEXA), although there are other methods. DEXA 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 BMD testing.

Screening for osteoporosis is recommended for women age 65 or older.¹ Women ages 60 to 64 should be screened if they also have at least one risk factor in addition to menopause. Risk factors include:

• Being white (Caucasian) or, to a lesser degree, being Asian.
• A family history of osteoporosis.
• Being thin.
• Long-term use of corticosteroids, such as prednisone or hydrocortisone for inflammatory conditions, or anticonvulsants, such as carbamazepine (Tegretol), phenytoin (Dilantin), or gabapentin (Neurontin) for pain or seizures.
• Eating disorders or diseases that affect the absorption of nutrients from food.
• Being inactive or bedridden for a long period of time.
• Smoking.
• Drinking excessive amounts of alcohol or beverages containing caffeine.
• Having a diet low in calcium or vitamin D.

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 mineral density than women at middle age, osteopenia and osteoporosis tend to happen at an older age in men. However, aside from the hormonal change in women as they go through menopause, the risk factors of osteopenia are risks for men as well as women. Men are also at risk if they have low levels of the hormone testosterone. Talk with your health professional if any risk factors apply to you.

How is osteopenia treated?

Osteopenia is treated by taking steps to keep it from progressing to osteoporosis and, for a few people, by taking medication. Lifestyle changes can help reduce the bone loss that leads to osteopenia and osteoporosis.

Diet 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.

Your health professional 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 sunlight.

Exercise is important in maintaining 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 health professional or a physical therapist about starting an exercise program.

In addition to diet and exercise, quitting smoking and avoiding excessive use of alcohol, cola, and caffeine will also reduce your risk of bone loss.

There are medications available to treat bone thinning, but these are more commonly used if you have progressed past osteopenia to the more serious condition of osteoporosis. Medications that may be used for osteopenia include bisphosphonates, raloxifene, and hormone replacement. For more information on these medications, see the topic Osteoporosis.

How can osteopenia be prevented?

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. However, 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 prevent osteoporosis.

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 caffeine, cola, and excessive alcohol. If you have children, teach them to make a nutritious diet and exercise part of their normal routine, make sure they play a little in the sunshine to help their bodies make more vitamin D, and help them avoid smoking and alcohol as they get older.

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 osteoporosis.

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Last updated:	December 01, 2006
Author:	Robin Parks, MS
Reviewed By:	Joy Melnikow, MD, MPH - Family Medicine, Carla J. Herman, MD, MPH - Internal Medicine
Editors:	Kathleen M. Ariss, MS, Pat Truman