What Is Osteopenia

Introduction

Osteopenia is made up of two words ‘osteo’ and ‘penia’. Osteo refers to bone, while penia refers to poverty. Osteopenia thus means a reduced bone mass (or to be more precise, reduced bone mineral density) compared to normal levels. This leads to weaker bones that are at a higher risk of fractures. It happens at around 50 years of age and is mostly observed in people assigned female at birth (AFAB). 

Bone mineral density is calculated by a Dual Energy X-ray Absorptiometry (DEXA) scan, the results of which are measured in “t-score”. There is a normal unit for bone density of a healthy adult and t-score results provide a score according to the standard deviation from the healthy range.¹

T-score results are differentiated in the following manner: 

• A score of +1 to -1: This is the normal range of bone mineral density for a healthy adult.
• A score of -1 to -2.5: This score means a little lower than the normal range for bone mineral density. This is the osteopenia stage.
• A score of -2.5 and below: This score means a very lower than normal range for bone mineral density. This is classified as the osteoporosis stage.

Results might also include a Z-score which is a comparison of bone mineral density with people in the same age and gender group. A low Z-score indicates a health condition that might be affecting the levels of bone mineral density.

Osteopenia vs Osteoporosis 

Osteoporosis is a health condition where the bones become fragile increasing their risk of fracture. Osteoporosis is usually diagnosed after having any injury or going for a routine check-up. This condition slowly develops over the years. Osteopenia is the stage before osteoporosis where bones are not extremely weak. Osteopenia does not always lead to osteoporosis. If it is diagnosed early and proper treatment is given, the chances of having osteoporosis are low. 

Causes of Osteopenia

Osteopenia can be caused due to a variety of factors:

• Hyperthyroidism: Hyperthyroidism is caused by an overactive thyroid where the thyroid gland releases more than the normal amount of thyroid hormones. Hyperthyroidism affects several body parts. If hyperthyroidism is left untreated, it can lead to osteopenia and osteoporosis. 
• Medications: Some medications can weaken bones and cause osteopenia. This includes medications for cancer, heartburn or seizures.
• Menopause: People AFAB are prone to osteopenia. They experience hormonal changes during menopause which can cause osteopenia.
• Diet: Poor diet can cause malnutrition and may cause health troubles. Calcium and Vitamin D are essential for good bone health. If a diet is lacking calcium or Vitamin D, there are chances of developing osteopenia.
• Lifestyle factors: Poor lifestyle choices such as smoking, drinking excessive caffeine or alcohol and not leading a physically active life can increase the chances of osteopenia.
• Surgery:  All surgeries pose minor health risks or side effects. In the case of gastrointestinal surgeries, the body is not fully able to absorb vitamins and minerals from diet. This can increase the chances of osteopenia. 

Risk factors of Osteopenia

Risk factors for osteopenia are: ²

• Age: All people over the age of 50 years are prone to osteopenia.
• Sex: People AFAB are more prone to osteopenia compared to people assigned male at birth (AMAB).
• Menopause: All people AFAB who reach menopause are prone to osteopenia due to hormonal fluctuations.
• Body Mass Index (BMI): Low BMI can be a risk factor for osteopenia and osteoporosis. 

Symptoms of Osteopenia

There are usually no symptoms of osteopenia or osteoporosis until the patient goes for a routine health check-up or suffers an injury. Few people with osteopenia might suffer from bone pain or weakness.

Diagnosis of Osteopenia

Osteopenia can be diagnosed during health check-ups or during diagnosis following an injury.¹

• DEXA Scan: Dual-Energy X-ray Absorptiometry (DEXA) scan is referred to as the gold scan for evaluating bone mineral density and diagnosis of osteopenia or osteoporosis. This scan provides results as t-score and z-score. It involves some radiation exposure. A z-score is important when dealing with young patients suspected of osteoporosis
• Physical examination: If you are old or a suspect for osteopenia, consult your healthcare provider and they might perform some physical examination to confirm the diagnosis
• Family history: Healthcare providers will check for a family history of osteoporosis or a history of fractures in the family

Treatment of Osteopenia

If osteopenia is detected, bone mineral density needs to be preserved as much as possible. Else it raises the chance of fractures. Some of the treatment options for osteopenia and osteoporosis are: ³

• Lifestyle changes: Unhealthy lifestyle choices like smoking, drinking excessive alcohol or lack of physical activity can be a reason for osteopenia or osteoporosis. Making lifestyle changes like quitting smoking, limiting the consumption of alcohol, or engaging in physical activities and exercising daily helps a lot in improving osteopenia. Exercise slows down bone loss after menopause.
• Calcium and Vitamin D supplements: Vitamin D deficiency can cause osteoporotic fractures. Studies have shown that daily consumption of around 800 IU of Vitamin D in addition to 1000-1200 mg of calcium helps in reducing the chances of osteoporotic fractures. 
• Bisphosphonates: These medications help to slow down the rate at which bones break down. Different bisphosphonates available are alendronic acid, zoledronic acid, ibandronic acid and risedronate. They can be given in the form of a pill, liquid or an injection. They might take 6-12 months to work. Side effects associated with these medications are irritation to the food pipe, swallowing problems and stomach pain. 
• Selective oestrogen receptor modulators (SERMs): These medications act like the hormone oestrogen which helps in maintaining bone density, thus reducing the risk of fractures. Raloxifene, the first SERM developed, was used for breast cancer prevention as well as osteoporosis. It is mostly recommended for people AFAB after menopause. This tablet needs to be consumed daily. Side effects of Raloxifene are hot flushes, cramps in the leg and the chance of developing blood clots. 
• Parathyroid hormone: Parathyroid hormones regulate the amount of calcium in the body. They help in increasing bone density by creating new bone cells. Side effects include nausea, dizziness and headache. They can be taken in the form of injections daily.
• Hormone replacement therapy (HRT): Hormone replacement therapy is prescribed for people AFAB going through menopause to control their symptoms. It helps in strengthening the bones and reducing the risk of osteopenia or osteoporosis. Some types of HRT are associated with an increased risk of breast cancer. 

Complications

Osteopenia poses some health risks if left untreated. As already mentioned, it is the stage before osteoporosis. This condition increases the risk of fractures even after minor falls. There can be some bone pain in a few patients. 

Frequently asked questions

Is osteopenia a serious problem?

Osteopenia is not as serious as osteoporosis. Osteopenia increases the risk of developing osteoporosis and suffering from fractures even after minor injuries.

Is osteopenia considered a disability in the UK?

No. Osteopenia is not considered a disability in the UK as it refers to less than normal bone mineral density. But, it can cause fractures easily or make life difficult. So, the impact it has on your health can determine what benefits you can get. For any clarifications, please reach out to your healthcare provider.

Is osteopenia a form of arthritis?

No. Osteopenia is low bone mineral density that makes the bones weak. Osteoarthritis is caused due to cartilage breakdown which leaves the bones unprotected.

Is osteopenia painful?

No. Osteopenia is generally painless. Some people can experience slight bone pain. It is usually diagnosed during routine health checkups or after suffering from an injury.

Summary

Osteopenia is the stage before osteoporosis where bone mineral density is very low compared to the average levels. Causes of osteopenia include poor nutrition, smoking, consuming excessive alcohol, lack of physical activity, cancer medications, seizure medications, heartburn medications, poor diet, calcium or Vitamin D deficiency, hyperthyroidism and surgery. People over the age of 50 years, AFAB especially after menopause, and people with low BMI are prone to developing osteopenia.

Osteopenia or osteoporosis can be treated with bisphosphonates, calcium and Vitamin D supplements, quitting smoking, reducing the consumption of alcohol, daily exercises, selective oestrogen receptor modulators, parathyroid hormones and hormone replacement therapy. 
Osteopenia has a chance of developing into osteoporosis, but it's not always the case. Preventive measures on time can help maintain bone mineral density and strengthen the bones. You can contact your healthcare provider or Royal Osteoporosis Society for any support.