What’s the difference between osteopenia and osteoporosis?

 A smiling mid adult male doctor sits at a table with an unrecognizable coworker.  He uses a human skeletal model as a visual aid during a discussion.

What’s the difference between osteopenia and osteoporosis?

The majority of us are familiar with the term osteoporosis.  But, osteopenia – that is a different story. Likely we have heard the word, knew it had something to do with bones but have been unable to say exactly what it means. 

The best way to understand osteopenia is to consider it as a midpoint between having healthy bones and having osteoporosis.  When we look at the words osteopenia and osteoporosis, it’s easy to see how the two can be confused.  Aside from the similar spelling, the conditions both relate to bone density.  Osteopenia is a condition in which bone mineral density is lower than normal but not to the extent of osteoporosis, the brittle bone disease.  The decreased bone density of osteopenia can lead to bone weakening and bone fragility with an increased risk of breaking a bone. 

Just like prediabetes is a precursor to type 2 diabetes osteopenia is a precursor to osteoporosis even though not everyone with osteopenia will develop osteoporosis.  Unlike osteoporosis, osteopenia is not considered a disease but rather is an indicator for risk of fractures.

Between the ages of 30-35 is when our bones are usually at their peak bone density.  After age 35, the formation of new bone slows down to the point where our bodies get rid of more bone than what it is creating.  Osteopenia can take years to develop and is often not seen until after age 50. 

Risk factors and causes of osteopenia

Throughout life, our bones are constantly changing.  New bone is growing while old bone is being broken down and reabsorbed by your body.  Once total bone mass has peaked, you start to lose it since your body is breaking down old bone faster than you can grow new bone.  Lose enough bone mass, and your bones may weaken. 

There can be multiple causes and risk factors of this bone condition which include the following:

·      Family history of osteopenia or osteoporosis

·      Women – they naturally have lower bone mass than men, they live longer than men and their calcium intake is usually lower than men

·      Hormonal changes, including decreased estrogen in women after menopause or decreased testosterone in men

·      Smoking

·      Excessive consumption of alcohol

·      Small, thin frame

·      Immobility

·      Certain medication such as corticosteroids, including prednisone and anti-seizure medications

·      Malabsorption of nutrients due to conditions such as celiac sprue

·      Chronic inflammation due to medical conditions such as rheumatoid arthritis

·      Anyone with an eating disorder such as anorexia or bulimia

·      Untreated celiac disease

·      Exposure to chemotherapy or radiation

·      An overactive thyroid – too much thyroid medication may lead to thinning bones

·      Lifestyle causes – lack of calcium or vitamin D or not enough exercise, especially strength training

Diagnosing osteopenia

Getting an accurate diagnosis of osteopenia can be somewhat difficult because of the fact it usually does not have any symptoms.  Losing bone mass is not painful.  The best way to determine if a person has this condition is to have a bone mineral density test

A bone mineral density test uses x-rays to estimate how thick or dense your bones are by measuring the amount of minerals such as calcium in the bones.  This fast, painless test is important for people who are at risk of osteoporosis, especially women and older adults.  The test is also referred to as dual energy x-ray absorptiometry or DXA. 

The National Osteoporosis Foundation recommends the test for the following people:

·      Women age 65 or older and men age 70 and older

·      Postmenopausal women 50 or older

·      A woman at the age of menopause who has a high risk for breaking bones

·      Men who are older than 50 with risk factors

·      Anyone who breaks a bone after age 50

·      Adults with a medical condition associated with bone loss such as rheumatoid arthritis or who take a medication causing bone loss such as prednisone or other steroids

Treating osteopenia

Everyone should take steps early in life to prevent osteopenia and particularly anyone with a family history of the condition or of osteoporosis.   Even if a person already has osteopenia, it is not too late to prevent it from turning into osteoporosis with the following strategies:

·      Get in enough calcium and vitamin D – this may be the most important thing you can do for your bones at any stage of life.  Get calcium by consuming more dairy products such as yogurt, cheese, milk, and cottage cheese. Also obtain calcium from other foods such as spinach, broccoli, dried beans and salmon. 

Vitamin D helps our body to absorb calcium.  It can be found in eggs, oily fish such as salmon and sardines and milk fortified with vitamin D.  It is also a good idea to spend 15-20 minutes in the sun twice a week at midday when we will absorb vitamin D the best helping our body to convert sunlight into this critical vitamin.

·      Lifts weights – Regular, weight-bearing exercise can help to prevent or slow osteopenia.  Talk with your doctor before starting a strength-training program 

·      Don’t smoke – Smoking can prevent the absorption of nutrients such as calcium and vitamin D.

·      Reduce intake of alcohol – Excessive alcohol consumption can also reduce absorption of critical nutrients important for bone formation. 

·      Medications – Sometimes prescription medications are used to treat osteopenia if bones are beginning to get weak.  Common medications used to treat it might include Fosamax, Boniva, Evista, Actonel, or Reclast.