Dr. Richard Martinez, a radiologist on staff at Lake Charles Memorial Hospital, answers your questions about osteopenia.
What is osteopenia?
By the time we reach our 30's, our bones naturally become thinner as existing bone cells are reabsorbed by the body faster than new bone is made. As this occurs, the bones lose minerals, making them weaker and increasing their risk of breaking.
Osteopenia is often the first stage of a progressive deterioration of the bone. It actually refers to a lower bone density than normal, but not as low as found in osteoporosis.
Who is most at risk for developing osteopenia?
Women are far more likely to develop osteopenia and subsequently osteoporosis. This is because women have a lower bone mass than men, and because the loss of bone mass speeds up as hormonal changes take place at the time of menopause.
But men can develop osteopenia and osteoporosis, as well.
In both men and women, other factors can contribute to osteopenia, including:
- Eating disorders or metabolism problems that do not allow the body to take in and use enough vitamins and minerals
- Chemotherapy, or medicines such as steroids used to treat a number of conditions, including asthma
- Exposure to radiation
And the risk increases for those with 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.
What are the symptoms?
Osteopenia has no symptoms. But as the bone becomes thinner, the risk of breaking a bone increases.
How is osteopenia diagnosed?
Osteopenia is diagnosed with a bone mineral density (BMD) test, a 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.
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 for inflammatory conditions, or anticonvulsants 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.
- Drinking excessive amounts of alcohol.
- Having a diet low in calcium or vitamin D.
Men who are older than age 70, or who have other risk factors for osteoporosis, should also have a bone mineral density test. Since 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. But 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.
How is it treated?
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.
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 doctor may also want you to take a calcium supplement often combined with vitamin D, which helps your body absorb calcium and other minerals. Vitamin D 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. 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 available to treat bone thinning, but these are more commonly used if you have progressed past osteopenia to the more serious condition of 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. 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 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 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. Most doctors suggest daily vitamin D supplements for children and teens, starting by age 2 months. Talk with your doctor about how much and what sources of vitamin D are right for your child.
If you're older than 30, it's still not too late to make these lifestyle changes. Talk to your doctor about your risks. 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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