What Is The Best Treatment For Osteopenia?

Introduction

When you think of ageing, you think of growing weaker and aching bones. The reality is that this process is caused by something much deeper than just “getting old.” Continue reading to find out what osteopenia is and how it can be treated/prevented.  

Osteopenia

What is it?

Do you often feel tired or sore in your bone/joint areas? You may be developing or suffering from a condition called osteopenia. Osteopenia is the state of your bones where your bone mass is lower than normal, resulting in weaker and more brittle bones.¹ 

It is a common condition that comes with ageing, especially when you have a peak bone mass around 35 years old. Osteopenia usually develops after 50 years of age; however, the exact age for when it might start heavily depends on how strong your bones were in your youth. 

If you had sturdy bones when you were younger, you might never actually get osteopenia. If your bones are naturally brittle and you experienced frequent bone fractures/broken bones while you were young, you may be more susceptible to getting osteopenia and may develop it earlier than “normal”.

Causes

Osteopenia is more common than one might think. In fact, the main cause of osteopenia is the process of regenerating/remodelling the bones in the body. In other words, the old bones are removed and replaced with new bone tissue.² There is a balance in the process of regeneration (new bones) and absorption (old bones), which contributes to the total bone mass. When your body eventually starts to break down the old bone at a faster rate than the growth of new bone, it causes the decline of the bone mass. The loss of bone mineral density is known as osteopenia. This leads to the weakening of the bones and can often lead to breakages or fractures, called osteoporosis (a higher degree of bone loss). 

There are several causes that can contribute to the development of osteopenia.³ Firstly, women are more susceptible to getting osteopenia because they have a lower bone mass and absorb less calcium than men. Women also typically live longer than men, which means that their bones will grow older as they have more time to age. Additionally, the rate of bone loss in women increases rapidly after they reach menopause; this is due to the decrease in estrogen levels that all women experience during menopause. If the ovaries (produce oestrogen) are removed or affected by diseases, bone loss occurs at a rapid rate.  

Osteopenia vs Osteoporosis

The two conditions are related to each other as they can be referred to as ‘the different stages of bone mass loss disease’. While osteoporosis is a very serious bone loss disease where any minor trauma can cause major complications, osteopenia can be viewed as the predecessor of that stage. Osteopenia is the stage between having healthy bones and having osteoporosis, meaning that your bones are still weaker than normal, but they do not break as easily as if you had osteoporosis. Osteopenia would only be diagnosed when your bones reach a bone mass level that is very low after taking an X-ray to determine the thickness of your bones. 

Risk factors

Osteopenia is a condition that cannot always be avoided, as bone mass loss is a natural process which can be different among individuals. There are some risk factors that increase the likelihood of developing osteopenia -^3,4

• Race: Studies have shown that specific races are more susceptible to developing osteopenia or having weak bones in general. Caucasian and Asian groups are more likely to have weak bones and may suffer from earlier onset of osteopenia as opposed to Black and Hispanic groups.
• Gender: Women are more likely to develop weaker bones and experience bone loss after menopause and other hormonal effects. Similarly, if you began your menopause early (before 45 years old), you may be at increased risk for developing osteopenia.
• Family history: If you have a familial history of either osteopenia or osteoporosis, you may be genetically susceptible to the condition. 
• Other pre-existing conditions: If you have hyperthyroidism (a disease where your body produces too many thyroid hormones) or have undergone surgery where your ovaries have been removed (thus affecting your oestrogen production), then you may also be susceptible to developing osteopenia. 
• Food habits: Your diet plays a major role in the healthy development of your bones. People who have eating disorders such as anorexia or bulimia starve themselves from the essential nutrients that their body needs to sustain their bones and consequently develop weaker bones.
• Chemotherapy may weaken your bones and cause bone mass loss over time due to the radiation in the treatment.
• Medications can also cause osteopenia, including anti-seizure medication, steroids, or gabapentin (for nerve pain).
• Your lifestyle can also encourage early osteopenia; if you consume a diet that lacks vitamin D or calcium, have reduced physical activity or are a smoker and heavy drinker. 

Prognosis

In general, the prognosis for osteopenia is good if they follow the suggested dietary and exercise recommendations.⁵ The correct treatment can stabilise bone densities and minimise the risk of bone fractures with efficient medication and/or supplements. As discussed, the primary complication of osteopenia is the deterioration to a severe stage of bone mass loss, known as osteoporosis.

Treatments for Osteopenia

The best way to treat osteopenia is to first change your lifestyle, including unhealthy dietary habits. Other methods include:⁶

• Avoid smoking and limit your alcohol intake; these are key to maintaining a healthy lifestyle. 
• Consume a healthy diet that consists of all the essential nutrients that your body needs to develop/keep strong and healthy bones.⁶ This would be a diet with plenty of nutrients, fruits, vegetables, and calcium. You can also eat dairy products (yoghurt, milk, cheese), spinach, broccoli, beans, eggs, and salmon, which are foods that are rich in calcium and vitamin D. The recommended daily intake of calcium is 1,200 mg.
• Develop a healthy exercise regimen that includes weight-bearing exercises. This involves walking, jogging, and climbing steps to prevent or slow the progression of osteopenia.
• If your bone mass levels are significantly low (osteoporosis), your doctor will advise that you start taking supplements. Vitamin D and calcium supplements are an easy and effective way to ensure that you always get your required daily dose of vitamin D and calcium. If you already have osteopenia, you may be prescribed medication to treat it during its dangerous levels, such as alendronate, raloxifene, risedronate, or zoledronic acid. These are not over-the-counter medications, and you should always consult with your doctor before starting these medications. 

Figure: Treatment Options for Osteopenia

Created by Aastha Malik

Summary

In conclusion, osteopenia is a condition where your bones become fragile (low bone mass density). Getting treatment as soon as possible can help slow the rate at which osteopenia develops into more severe conditions, such as osteoporosis. It is important that you talk to your doctor if you are experiencing any kind of pain around your bones or other symptoms of osteopenia.