Osteopenia: Early Signs of Bone Loss and How to Strengthen Your Bones

What is osteopenia?

Osteopenia is a condition characterised by lower-than-normal bone mineral density (BMD). It's a precursor to osteoporosis, which is more severe bone loss. In osteopenia, bones lose some of their mass and become weaker, though not to the extent seen in osteoporosis. Think of it as your bones giving you an early warning that they need more care and attention to stay strong.

What's the difference between osteopenia vs. osteoporosis?

While both osteopenia and osteoporosis involve loss of bone density, they differ in severity:

• Osteopenia is defined as a BMD score between -1 and -2.5 on a bone density test. It means your bones are weaker than normal but not as fragile as in osteoporosis.
• Osteoporosis is more advanced bone loss with a BMD score below -2.5. Bones become very porous and prone to fractures, even from minor falls or bumps.

So osteopenia is like a yellow alert for your bone health, while osteoporosis is the red alert, signalling a higher fracture risk. Identifying osteopenia symptoms early allows you to strengthen your bones with a proper osteopenia treatment plan before they deteriorate further.

How common is osteopenia?

Osteopenia is quite common, especially as we age. According to the National Osteoporosis Foundation, over 43 million American adults have low bone mass or osteopenia. It's estimated that about half of adults over 50 have some degree of bone loss. Women, particularly after menopause, have a higher risk due to hormonal changes that accelerate bone loss.

What are osteopenia symptoms?

One tricky aspect of osteopenia is that it usually doesn't cause noticeable symptoms. You can't feel your bones getting weaker. However, some osteopenia symptoms or signs to watch out for include:

• Recurrent stress fractures or fractures from minor trauma
• Loss of height over time
• Back pain or changes in posture due to compression fractures in the spine

What causes osteopenia?

Osteopenia causes can be broadly divided into two categories:

• Natural bone loss with ageing: Our bones are constantly breaking down and rebuilding. However, around age 30, bone loss starts outpacing formation, leading to a gradual decline in bone density. For women, menopause speeds up this bone loss.
• Medical conditions and medications: Certain health issues and treatments can trigger bone loss, such as:
  • Rheumatoid arthritis and other inflammatory diseases Thyroid and parathyroid disorders
  • Celiac disease and inflammatory bowel disease
  • Chemotherapy and radiation therapy
  • Long-term use of corticosteroids and some anti-seizure drugs

What are the risk factors for osteopenia?

In addition to age and gender, other factors that increase your likelihood of developing osteopenia include:

• Family history of osteoporosis or fractures
• A sedentary lifestyle and lack of weight-bearing exercise
• Poor nutrition, especially low calcium and vitamin D intake
• Smoking and excessive alcohol use
• Low body weight or small bone structure
• Certain ethnicities, such as Caucasian and Asian women

Being aware of these risk factors can help you take proactive steps towards possible osteopenia treatment. For example, if you have a family history of osteoporosis, you might consider getting a bone density test earlier than the generally recommended age of 65.

What are osteopenia complications?

The main complication to watch out for with osteopenia is an increased risk of fractures.

• When bones lose density, they become more fragile and prone to breaking, even from minor falls or bumps. Fractures can lead to pain, disability, loss of independence, and in severe cases, complications like blood clots or infections.
• Spinal compression fractures are a particular concern. These tiny cracks in the vertebrae can cause back pain, loss of height, and a stooped posture. Multiple compression fractures can lead to kyphosis or a "dowager's hump."
• While fractures are a more immediate complication, osteopenia can also progress to osteoporosis if left unchecked. That's why early diagnosis and treatment are key to preventing fractures and maintaining good bone health.

How is osteopenia diagnosed?

The gold standard for diagnosing osteopenia is a bone mineral density (BMD) test, usually done using a special X-ray called dual-energy X-ray absorptiometry (DEXA). This painless scan measures the density of your bones, typically at the hip and spine. The results are reported as a T-score, which compares your BMD to that of a healthy 30-year-old adult:

• A T-score between -1 and -2.5 indicates osteopenia
• A T-score below -2.5 means you have osteoporosis

The DEXA scan gives your doctor a snapshot of your bone health and helps guide treatment decisions. Your doctor may also recommend blood tests to check for underlying health conditions that could be contributing to bone loss.

What is the treatment for osteopenia?

The goal of osteopenia treatment is to prevent further bone loss and reduce the risk of fractures. The approach is typically twofold:

1. Lifestyle changes

• Ensuring an adequate intake of calcium (1000-1200 mg/day) and vitamin D (600-800 IU/day) through diet and supplements
• Engaging in regular weight-bearing and resistance exercises to stimulate bone-building
• Quitting smoking and limiting alcohol intake
• Ensuring overall healthy nutrition and maintaining a healthy body weight

2. Medications

• Bisphosphonates: These drugs slow down bone loss and reduce fracture risk. They're usually reserved for people with more significant bone loss or additional risk factors.
• Hormone therapy: For women in early menopause, estrogen therapy can help prevent bone loss. However, it does carry some risks, so it's not routinely recommended solely for bone health.
• Other medications: Depending on your specific situation, your doctor might consider other drugs to strengthen your bones, such as raloxifene, denosumab, or teriparatide.

It's important to work closely with your healthcare provider to develop a personalised osteopenia treatment plan based on your bone density, fracture risk, and overall health. Regularly monitoring your bone density can help track your progress and adjust the treatment as needed.

Can you prevent osteopenia?

While some bone loss is a natural part of ageing, there's a lot you can do to keep your bones as strong as possible:

• Get enough calcium and vitamin D: Aim for 1000-1200 mg of calcium per day from dairy products, leafy greens, and fortified foods. Get vitamin D from sunlight exposure, fatty fish, egg yolks, and supplements if needed.
• Exercise regularly: Weight-bearing activities like walking, jogging, and dancing, and resistance training with weights or bands can stimulate bone formation. Aim for at least 30 minutes most days of the week.
• Don't smoke and limit alcohol: Both habits can accelerate bone loss and increase fracture risk.
• Consider bone-density screening: If you're a woman over 65, a man over 70, or have risk factors for osteopenia, talk to your doctor about getting a DEXA scan to check your bone health.

What can we expect if we have osteopenia?

If you have osteopenia, expect a decrease in bone density, which raises the risk of fractures but doesn’t always mean you’ll develop osteoporosis. Regular exercise, calcium, and vitamin D can help slow bone loss. Your doctor might suggest lifestyle adjustments or medications to maintain bone health and reduce fracture risk.

Can we reverse osteopenia?

While there's no cure for osteopenia, the bone loss can be slowed down or even reversed to some extent. With the right combination of lifestyle changes and medical treatment, it's possible to improve your T-score on a DEXA scan over time.

Some studies have shown that bisphosphonate drugs, when used consistently, can increase bone density by about 5% over 3-4 years. Exercise and adequate calcium and vitamin D intake have also been shown to have a positive impact on bone density.

When to see a doctor?

If you have risk factors for osteopenia or osteoporosis, it's a good idea to discuss bone health with your doctor. Some specific reasons to seek medical advice include:

• You're a woman over 65 or a man over 70
• You have a family history of osteoporosis or fractures
• You've had a fracture from a minor fall or injury
• You have a medical condition or take medications that can affect bone health
• You have symptoms like back pain, loss of height, or changes in posture

Conclusion

Osteopenia may be a silent condition, but it's an important wake-up call for your bone health. If you're concerned about your bone health, consider reaching out to Metropolis Healthcare for a bone density scan and personalised recommendations. With a network of state-of-the-art diagnostic labs across India and a team of expert phlebotomists for at-home sample collection, Metropolis can be your trusted partner in assessing and monitoring your bone health. Prioritise your bone health today, and your future self will thank you!