Osteopenia is a condition involving the bones and it’s characterized by having bones that contain lower density than normal. A person with osteopenia has bones that are brittle and weaker than normal. Osteopenia may not be considered a disease, but is a state or condition of the bones. With this condition, the bone density isn’t low enough to reach the levels of osteoporosis, also it isn’t high enough to be within the normal range. Osteopenia may precede osteoporosis, so it can be a warning sign for a more serious bone health problem.3
Osteopenia occurs when an individual has bones that have become weaker and lost minerals. This makes the bones to be less dense, fragile, and prone to having breakage. Bone mineral density or bone mass is the mineral content within the bones or simply the mineral concentration in your bones. Osteopenia is more common in woman that it is seen in men. Women tend to have lower levels of bone density compared to their counterpart men. Also, some hormones of the reproductive system particularly estrogen can affect the way or the rate of bone mass creation or loss.1,2,3,4,5
Women aged 65 and above and those who are postmenopausal with bone loss risk factors need to be tested for the condition or another condition like osteoporosis. The widely available DXA scan is considered accurate in diagnosing patients of both osteopenia and osteoporosis.
While osteopenia can affect many people, not every person needs to be treated using prescription medicines. A doctor can evaluate the need for use of medication verses the need for non-medication therapies like exercises and dieting to help increase bone density and strength. Taking sufficient amounts of vitamin D and doing away with alcohol and smoking, and having plenty of exercises are some of the things that could aid in preventing osteopenia.7
When Does Osteopenia Develop?
Bones are densest around the age of 30, but that begins to decrease with time. If osteopenia happens, it is usually around the age of 50. Depending on how an individual’s bones have been strong when they were young, the age at which osteopenia develops may vary. If a person had hardy bones during their youthful and young adult stages, they may not have osteopenia. However, if your bones are not naturally dense, it is likely that you will get the condition much earlier.1
Who Gets Osteopenia?
When the body removes more bone compared to how much it is creating, it could lead to osteopenia. Some individuals may have genetic predisposition in having osteopenia. So if your family has had the condition, it could occur to you. Women survive for long meaning their bones are able to age more. Women also don’t get a lot of calcium like men and you know that this mineral is the key to the health of your bones. At menopause, hormonal changes happening in women may increase the chances of developing osteopenia. In men, having lower levels of testosterone gives you higher chances of getting the condition.1
If you aren’t getting enough exercise or if you had ovaries removed before menopause, you have higher chances of developing osteopenia. Taking medication like phenytoin and prednisone puts you at risk of the condition. Smoking and use of tobacco may increase your susceptibility to getting the condition.4
Causes of Osteopenia
Osteopenia may be caused by different things. Sometimes, medical conditions are the culprit. At other times, drugs you are taking may trigger osteopenia. Medical causes include:1
- Having eating disorders like bulimia and anorexia that starve the body of the required nutrients to help keep the bones healthy and strong
- Untreated celiac disease makes it difficult for food absorption to take place in the intestine. People with celiac disease may have damages on their small intestine when they eat food containing gluten.
- An overactive thyroid may be implicated in osteopenia. Having too much medication for thyroid may also contribute to the reduced bone density
- Chemotherapy or exposure to radiation during cancer treatment may have effects on your bone density
- Certain medications are thought to trigger osteopenia and they include: seizure drugs like gabapentin, carbamazepine, and phenytoin. Steroids like prednisone and hydrocortisone may also cause osteopenia.
There are other causes associated with an individual’s lifestyle that may cause osteopenia and they include:1
- Lack of exercise
- Too much, regular alcohol
- Carbonated beverages
- Lack of vitamin D and calcium
Symptoms and Signs
A majority of people having osteopenia don’t know they have it because there are no inherent symptoms present. However, symptoms can occur with time and when they do, they include the following:
- Having bone breaks or fractures. These may occur in the wrist, the spine, the ankle, or the hip
- Having bone pains and aches affecting tissues close to the bones as well as the joints
- Having problems with normal exercises because of injuries or pains.
When osteopenia occurs and shows symptoms, the pain in bones may be localized. There is weakness in the site or area where there has been bone fracture. An interesting thing is that at times, bone fractures may not cause pain.
Bone Density T Scores
It is easy to measure the density of bone, which is the quality of bone strength and mass. The standard test used to measure bone density is usually the bone density test and it is done by having CT scan for lumbar spine. This is known as QCT scan or quantitative computed tomography. Another bone density test is that done by dual energy X-ray absorption (DEXA).2
A numerical rating is provided by the bone density test. The most measured bones are those of the forearm, lumbar spine, and the hip’s femur bone. The results are quantified into T score. So having a lower T score indicates that you have lower bone density. If your T scores are greater than -1.0, you are considered to have normal bone density, which is an indication for a healthy bone. However if the T scores range from -1.0 to -2.5, it indicates that you have osteopenia. When T scores are below -2.5, you may be having osteoporosis.2
Diagnosis of Osteopenia
Because osteopenia doesn’t always present with symptoms, its diagnosis may be difficult unless tests are conducted to determine your bone mineral density. The National Osteoporosis Foundation says that if any of the aspects below apply in your case, you need to get a bone density test.
- A woman aged 65 and older
- Postmenopausal woman who is 50 and older
- A woman who has reached menopause and she has increased chances of having bone breakage
- A man who has reached 50 and has risk factors
- If you have broken a bone after 50
DEXA or DXA test is the most common and it uses X-rays with lower radiation compared to typical X-rays. It is a painless test and will involve bones of the shin, heel, finger, wrist, spine, or hip. This dual energy X-ray absorptiometry technique looks to compare the density of an individual’s bone to that of a 30-year-old person of same race and sex. 4
Treatment for Osteopenia
Exercising the body
Exercise is important for the body when it comes to treating and preventing osteopenia. Exercise stimulates stronger bones and helps with fall prevention. You can take weight-bearing exercises along with strength exercises to help improve the health of the bones.
It is important that you modify your lifestyle by avoiding excessive alcohol and smoking. You also want to cut down on taking carbonated drinks.
You may need to have nutrient and vitamin supplements. For example, vitamin D and calcium supplements may be applied in the treatment protocol.
You should take foods rich in vitamin D and those containing calcium. This is important for the health of the bones in any stage of life. Calcium can be obtained from foods like:
- Dairy products like cheese, milk, and yogurt – choose those with low fat
- Dried beans
You can get vitamin D from eggs and oily fish like sardines and salmon. Vitamin D helps in the absorption of calcium. Other foods that have calcium and vitamin D are cereal, bread, and orange juice.
You may want to spend about 10 to 15 minutes in sunlight at least two times in a week because it allows the body to convert the sunlight into vitamin D. That’s an easy way of getting this important vitamin. Remember that too much exposure to sunlight may be harmful to the skin.
If the bones have started becoming weak, prescription medication may be used to help treat osteopenia. The medications include:
- zoledronic acid
ICD 10 Code
Osteopenia – 2018 ICD-10-CM Index. M85.8
- What Is Osteopenia? https://www.webmd.com/osteoporosis/guide/osteopenia-early-signs-of-bone-loss#1
- Osteopenia: Low Bone Density Risk Factors + 5 Natural Treatments. https://draxe.com/osteopenia/
- What Is Osteopenia? https://www.healthline.com/health/osteopenia
- Everything you need to know osteopenia: Causes, treatments, and prevention. https://www.medicalnewstoday.com/articles/318321.php
- Osteopenia: When you have weak bones, but not osteoporosis. https://www.health.harvard.edu/womens-health/osteopenia-when-you-have-weak-bones-but-not-osteoporosis
- Osteopenia. https://www.medicinenet.com/osteopenia/article.htm