Bone Loss: Stage Before Osteoporosis

Health Topics

picture of osteopenia
Bone gradually becomes brittle, porous and prone to fractures. In most cases osteopenia is a natural part of the aging process. Most women with osteopenia will not develop osteoporosis, although it does raise their risk factors.



What Is Osteopenia?
What Are The Symptoms?
What Causes It?
Does Everyone With Osteopenia Develop Osteoporosis?
How Is It Diagnosed?
How Is Osteopenia Treated?

What Is Osteopenia?

If you have osteopenia it means that your bones are becoming thin and brittle, but not brittle enough to be classified as osteoporosis. Technically, osteopenia means you have lower than normal bone mineral density (BMD). It is considered by some as a potential precursor to osteoporosis. Millions of women worldwide have been diagnosed with osteopenia and many are taking drugs to inhibit further bone loss. But, as these drugs have risks and their benefits are questionable, many health experts are now questioning if the diagnosis of osteopenia may be doing more harm than good.

What Are The Symptoms?

Osteopenia produces no obvious signs or symptoms. You are unlikely to experience pain as a result of bones become thinner and more brittle. However, there is an increased risk of bone fractures the more brittle your bones become.

What Causes It?

As we age, bones naturally become thinner. Existing bone cells are reabsorbed into the body faster than new ones can be made. As this happens the bone loses heaviness (density) and minerals, making them weaker, porous and prone to breaking and fracturing. All women start to naturally lose BMD after the age of 30. After the age of 40 we lose 1 to 5 percent of our BMD every year (the rate is only 1 percent in men). Hormones are a contributory factor for women. The sudden drop in estrogen (which is instrumental in building healthy bone tissue) around menopause contributes towards osteopenia (and in some eventually osteoporosis) by preventing the absorption of calcium and phosphates - both essential bone making ingredients. Other causes can also contribute to more rapid bone loss than normal:
• Chronic rheumatoid arthritis
• Eating disorders
• Chronic kidney disease
• Being thin
• Smoking
• Drinking cola drinks regularly
• Excessive alcohol or smoking
• Certain medications, including steroids like hydrocortisone or prednisone for inflammatory conditions and anticonvulsants such as Tegretol, Dilantin and Neurontin for pain or seizures.
• Diet low in vitamin D and calcium.

Does Everyone With Osteopenia Develop Osteoporosis?

No. If you receive a diagnosis of osteopenia, it simply means that your BMD is below the statistical norm for your age. Osteopenia is not considered a disease, whereas osteoporosis is. Osteopenia is a risk factor for osteoporosis (increases your chance of getting it), but it does not mean you will automatically develop it. According to some experts, the way we define osteopenia is too broad and crude - most women with osteopenia will not develop fragility fractures (one of the main symptoms of osteoporosis). It simply raises their risk.

How Is It Diagnosed?

Osteopenia is diagnosed by a bone mineral density (BMD) test. This test (usually done with a DEXA scan) is done to check for signs of osteoporosis. See diagnosis of osteoporosis for more details of this test. To qualify as osteopenic, your T-score must be lower than minus 1 (lower than minus 2.5 is osteoporosis). That means your bone density is one standard deviation below that of an average 30 year old - your bone density statistically just falls outside of the normal range. The main problem with this argument is that the definition of what is normal bone mass is contentious. The World Health Organization (WHO) defines it as that of an average 30 year old woman. But because bone naturally deteriorates with age, anyone much older than 30 by definition will be diagnosed with osteopenia. It's rather like saying a 50 year old has skin disease because she has wrinkles. The WHO said that its definition of osteopenia was never meant as a tool for diagnosis or prescribing drugs. Yet that is what is happening. Many doctors prescribe osteoporosis drugs to women diagnosed with osteopenia based on the WHO criteria (although some still take a more conservative approach and adopt a wait and see policy).

To counteract some of the diagnostic confusion, the WHO has developed a computer program to help predict a person’s risk of having a fracture related to osteoporosis within the next 10 years. You can take this test online at: www.sheffield.ac.uk/FRAX.

Bone loss medications may be required if your results show:
1. Your risk of hip fracture is 3 percent or more.
2. Your major osteoporotic risk (risk of any fracture) is 20 percent or more.

However, even this system is flawed. Experts complain that the mathematical formula behind the FRAX scores has not been released to the public, so there's no way to validate how accurate it is likely to be. While the tool takes into account smoking and drinking, it does not ask for how long or how much you do. Furthermore it does not ask the user for their history of medication use - epilepsy drugs and antidepressants for example can speed up bone loss.

How Is Osteopenia Treated?

The treatment for osteopenia is highly controversial. FRAX guidelines indicate medication should be prescribed when your risk of hip fracture is 3 percent or more, or your general risk factor is 20 percent or more. Professor of medicine at the University of California says while bone loss drugs work if you have osteoporosis, "some studies suggest there is little benefit, if any benefit at all, if you take these drugs when you have osteopenia." For more on these medicines see, osteoporosis treatment. Outside of drugs, lifestyle changes including diet and exercise can help reduce bone loss and may prevent osteopenia turning into osteoporosis. For more see osteoporosis prevention.

Bottom Line: If you have been diagnosed with osteopenia, educate yourself about what this means and make an informed choice on any treatments you may be offered.


Related Articles on Osteoporosis

For more information, see the following:

Bone and joint problems: A to Z of symptoms and diseases.
Evista: The designer drug that helps prevent osteoporosis.

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