A Guide to Osteopenia and Osteoporosis

As you get older, your bone mineral density decreases. Osteopenia occurs when your bone density is lower than normal for your age, but not so low that you’re at high risk of fracture. Osteoporosis occurs when your bone density is so low that you’re at higher risk of a fracture.

They are related conditions caused by the same problem — low bone density. But osteopenia is less severe than osteoporosis.

Osteopenia Is Common

About 43 million Americans have osteopenia: More than half of postmenopausal women have the condition. But men are at risk as well. About a third of white and Asian men over 50 are affected. (The rate is lower for some groups, with approximately 23% of Hispanic men and 19% of Black men affected.)

By contrast, about 10 million Americans have osteoporosis, the more severe form of low bone density.

Risks of Low Bone Density

Osteopenia and osteoporosis develop gradually and stealthily, making bones fragile and brittle. Because of the “silent” onset, these conditions may not seem like a formidable threat. Yet half of women over age 50 will break a bone because of osteoporosis. A woman's risk of breaking a hip is equal to her combined risk of breast, uterine and ovarian cancer, according to the Bone Health and Osteoporosis Foundation.

How Osteopenia and Osteoporosis Develop

Bones may seem hard and unchanging but they’re actually made of living cells that constantly grow and regenerate. That process breaks down with age, says Seema Maple, M.D., a family practice doctor with Sutter.

Osteopenia and osteoporosis occur “when existing bone breaks down faster than new bone is made,” she says.

Many factors besides aging can play a role in low bone density. A person’s risk is raised by:

• Smoking
• Drinking too much alcohol
• Insufficient calcium or vitamin D
• Not getting enough weight-bearing exercise
• Taking certain medicines like corticosteroids or chemotherapy

Diseases like rheumatoid arthritis or thyroid disorders also raise your risk.

Testing for Osteopenia and Osteoporosis

If you’re 50 or older or have recently broken a bone, talk to your doctor about taking a bone density test. A noninvasive test called dual energy X-ray absorptiometry (DEXA) can measure the exact quantity of calcium in a region of your bones.

The test will give you a “T-score” of your bone density. The lower your score the higher your risk of fracture. Young, healthy people have a T-score of 0. People with osteopenia have a T-score of -1 to -2.5.  People with T-scores below -2.5 have osteoporosis.

Tips for Osteopenia

Your doctor will recommend key lifestyle changes that can help preserve bone density.

• Do regular weight-bearing exercises. These include walking, dancing, low-impact aerobics, elliptical machines and even gardening.
• Get enough calcium and vitamin D. The National Osteoporosis Foundation recommends 1,200 to 1,500mg of calcium per day and 800 to 1,000 IUs of daily vitamin D for adults over the age of 50. Most people take supplements to reach those goals. But foods such as milk, cheese and leafy greens like spinach and kale are also high in calcium.
• Avoid smoking and limit alcohol.

Your doctor may also recommend medications that can increase bone density and help prevent osteoporosis.

If the condition is managed with diet, exercise and vitamin supplements, many people with osteopenia never go on to develop osteoporosis. Fewer than 10% of people with mild osteopenia progress to osteoporosis. Your risk increases if you have advanced osteopenia.

Some people can reverse osteopenia with treatment, although most live with it for life.

Tips for Osteoporosis

You have a higher risk of bone fractures if you have osteoporosis, especially in the spine or hip. “Osteoporosis creates a frail frame in the bone that’s susceptible to injury, even with minor falls or injuries,” Dr. Maple says. “This can lead to serious complications and even disability in older adults.”

Your doctor will likely prescribe medications that help rebuild bone or delay further bone loss. Medications come in various forms ranging from pill to patch to nasal spray or injection. Your doctor will weigh your personal preference, as well as your gender, age and severity of disease, to decide which medication to prescribe.

Because osteoporosis and your risk for falls progress with age, you’ll need to adjust your strategy with time. Taking a proactive approach to osteoporosis will ensure you keep your bones as strong as possible and prevent disabling injuries throughout your lifetime.

Protecting Your Bone Density

You can and should start protecting bone density as young as your teens. Here are some tips:

• Teens and young adults can build up bone density and strength by getting the recommended amount of calcium and vitamin D through diet and sunlight or supplements.

• Exercise to build and maintain bones, focusing especially on weight-bearing and muscle-strengthening exercises. These can include anything from dancing, hiking and tennis to fast walking, elliptical training or lifting weights.

• Avoid smoking or drinking more than one drink a day. Both habits accelerate bone loss.

• Wear flat, non-slip shoes to prevent falls.