Osteopenia: When you have weak bones, but not osteoporosis

Bone density test score determines whether you have osteopenia or osteoporosis

Like their names suggest, osteopenia and osteoporosis are related diseases. Both are varying degrees of bone loss, as measured by bone mineral density, a marker for how strong a bone is and the risk that it might break. If you think of bone mineral density as a slope, normal would be at the top and osteoporosis at the bottom. Osteopenia, which affects about half of Americans over age 50, would fall somewhere in between.

Osteopenia and bone density test

The main way to determine your bone density is to have a painless, noninvasive test called dual-energy x-ray absorptiometry (DXA) that measures the mineral content of bone. The measurements, known as T-scores, determine which category — osteopenia, osteoporosis, or normal — a person falls into (see graphic).

Fracture risk increases as bone mineral density declines. But there isn't a huge difference between, say, a -2.3 T-score and -2.5, although the former would be labeled osteopenia and the latter, osteoporosis. The label matters less than the number. These distinctions are to some extent arbitrary lines in the sand. Regardless of your exact score, if your bone density results fall into the osteopenia category, your doctors will probably schedule you for a bone mineral density test every two to five years.

The United States Preventive Services Task Forces (USPSTF) recommends bone density screening for

• Women 65 years or older
• Postmenopausal women younger than 65 years who are at increased risk for an osteoporotic fracture as estimated by clinical risk assessment.

According to the USPSTF, there is insufficient evidence to assess the balance of benefits and harms of bone density screening in men.

Osteopenia Prevention

Everybody's bones get weaker as they get older. But certain choices and habits accelerate the process. They include:

• not getting enough calcium and vitamin D
• smoking
• drinking too much alcohol
• using certain medications, such as corticosteroids or some anticonvulsants
• not getting enough weight-bearing exercise (at least 30 minutes on most days). If your feet touch the ground during an exercise, it's probably weight bearing. Running and walking are weight bearing. Swimming and biking are not.

Women are far more likely to have lower than normal bone density than men, but it's no longer viewed as solely a women's condition. About a third of white and Asian men over age 50 are affected. The percentages for Hispanics (23%) and blacks (19%) are lower, but still sizable.

Osteopenia treatment

Exercise and diet are the mainstays of osteoporosis treatment. Bones get stronger when we exert force on them by using our muscles. Weight-bearing exercise — such as resistance (strength) training or body-weight exercises — is an effective way to do this. Simply walking at a brisk pace reduces the likelihood of osteoporosis. Aerobic and balance exercises help reduce the risk of falling and suffering a fracture.

Get the right nutrients. Bones rely on calcium to get stronger, and your body needs vitamin D to absorb calcium. Aim for 1,000 IU of vitamin D and 1,000 milligrams of calcium per day. Try to get as much calcium as you can from food, such as dairy products, sardines, and leafy greens. If you're not getting enough calcium in your diet, ask your doctor if you should add a low-dose calcium supplement to make up the gap.

You should also consume plenty of protein, which helps build strong bones. Good sources include poultry, fish, legumes, and dairy products. Avoid or limit alcohol intake to no more than one drink per day, since alcohol can interfere with bone health.

Your doctor may recommend drug therapy, such as a bisphosphonate, if you have advanced osteopenia and also have

• had a previous spine or hip fracture
• a high risk for fractures in the next 10 years, as calculated with a bone density test (a DEXA scan) and a fracture risk assessment (FRAX) score

Image: © Ridofranz | GettyImages