Osteopenia: When you have weak bones, but not Osteoporosis

Although it sounds the same as osteoporosis, the two are not the same. This article will talk in-depth about osteopenia and how it is different from osteoporosis.

Osteopenia: When you have weak bones, but not Osteoporosis

So what is the difference between Osteopenia and Osteoporosis?
Both osteopenia and osteoporosis refer to “loss of bone mineral density”. However, the degree of bone loss is different. Osteopenia is a rather less severe form of osteoporosis. The lesser the bone mineral density, the weaker are the bones and the higher is the risk of bone fractures. People with osteopenia,however, are less likely to have fractures as compared to people with osteoporosis.

How do we differentiate between the two?
Heads up: science ahead. There is a rather sophisticated , but non-invasive, test known as dual-energy x-ray absorptiometry (DEXA) scan which measures the bone mineral density and uses scores known as “T scores” to quantify the degree of bone mineral loss. Based on the T scores, a person may be labelled to have normal bone mineral density, osteopenia or

So what causes Osteopenia?
Bones tend to get weaker with aging. Certain factors that can increase the tendency for osteopenia include
● Decreased hormonal levels including low estrogen (after menopause in women, for instance) or low testerone levels in males
● Smoking
● Alcohol consumption
● Diet low in calcium and vitamin D
● Less sun exposure
● Sedentary lifestyle
● Use of certain medications like steroids
● Surgeries such as removal of ovaries in women
● Malabsorption syndromes that affect absorption of calcium and vitamins by the gut

What are the symptoms?
Osteopenia manifests as
● Bone pains
● Back ache that improves with rest
● Curving or stooping of spine
● Loss of height
● Fractures

Should I get tested?
You might consider a test after talking to your GP if
● You are a female older than 65
● You are a male older than 70
● You are post menopausal with history of fractures
● Have a family history of bone problems
● Have been taking steroids for a long time

How can I prevent it?
● Regular weight bearing exercises, for example, running
● Exposure to sunlight for about half an hour everyday
● Diet rich in calcium and vitamin D including milk, cheese, cream, nuts, veggies, eggs, fruits etc
● Avoid smoking and alcohol intake
● Removal of fall hazards at home to prevent fractures

How is it treated?
Remember, not all osteopenia patients are prescribed medicines for treatment. Treatment of osteopenia is mostly symptomatic with more emphasis on lifestyle modification and treatment of underlying causes.
Your doctor will determine whether or not you need to be started on prescription medicines based on your symptoms and your T score obtained from the DEXA scan. Some of the common treatments given for osteopenia include
● Calcium and vitamin D supplements
● Bisphosphonates (such as Alendronate)
● Hormonal analogues (Raloxifene etc)
● Hormone replacement therapy
These medications have their own side effects some of which may even be life-threatening, which is why they should be taken carefully only if prescribed by a specialist.
Pay heed!

Osteopenia may not sound too menacing but it can precede osteoporosis. It is imperative to identify and treat it early to prevent the situation from deteriorating further. So take control of your health and talk to your doctor before it is too late.

1. Khosla S, Melton III LJ. Osteopenia. New England Journal of Medicine. 2007 May 31;356(22):2293-300.

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