From the Guidelines
Osteopenia is a condition where bone density is lower than normal but not low enough to be classified as osteoporosis, defined as a T-score between −2.5 and −1.0, indicating "low bone mass" or "low bone density" 1. To address osteopenia:
- Increase calcium intake to 1000-1200 mg daily through diet or supplements.
- Ensure adequate vitamin D intake (600-800 IU daily).
- Engage in weight-bearing exercises and strength training 3-4 times per week.
- Quit smoking and limit alcohol consumption.
- Consider medications like bisphosphonates if recommended by your doctor. Bone density naturally decreases with age, but osteopenia accelerates this process. The condition is diagnosed through a bone density scan (DEXA). While not as severe as osteoporosis, osteopenia increases the risk of fractures and should be taken seriously. Calcium and vitamin D are crucial for bone health, as evidenced by the updated practice guideline for dual-energy x-ray absorptiometry (DXA) 1. Weight-bearing exercises stimulate bone formation, while smoking and excessive alcohol can contribute to bone loss, as highlighted in the management of osteoporosis in survivors of adult cancers with nonmetastatic disease 1. Early intervention can prevent progression to osteoporosis and reduce fracture risk. It is essential to note that the definition of osteopenia is based on the World Health Organization (WHO) criteria, which defines osteoporosis as a T-score value less than or equal to -2.5 at the lumbar spine, one-third (33%) radius, femoral neck, or total hip 1. A T-score between −2.5 and −1.0 is defined as “osteopenia”, “low bone mass” or “low bone density” 1. In children and adolescents, premenopausal women, and men under the age of 50 years, the ISCD recommendation is to use Z-scores, although IOF has recommended use of T-scores in younger men and premenopausal women who are no longer growing 1. The American Society of Clinical Oncology 2003 update on the role of bisphosphonates and bone health issues in women with breast cancer also highlights the importance of osteoporosis prevention and therapy in breast cancer patients 1. Overall, osteopenia is a significant condition that requires attention and intervention to prevent progression to osteoporosis and reduce fracture risk, as supported by the most recent and highest quality study 1.
From the Research
Definition of Osteopenia
- Osteopenia is a chronic bone condition characterized by decreased calcification, density, or bone mass that, if untreated, can lead to osteoporosis and bone fractures 2.
- It is defined solely according to the statistical properties of the distribution of bone mineral density (BMD) values, which limits its usefulness in clinical care 3.
- By definition from the World Health Organization, osteopenia is defined by bone densitometry as a T score -1 to -2.5 4.
Causes and Risk Factors
- There are many causes for osteopenia, including calcium and vitamin D deficiency and inactivity 4.
- Genetics plays an important role in a person's bone mineral density, and often Caucasian women with a thin body habitus who are premenopausal are found to have osteopenia 4.
- Other risk factors include age, gender, and family history of osteoporosis.
Diagnosis and Treatment
- The diagnosis of osteopenia is primarily determined by measuring bone mineral density (BMD) using noninvasive dual-energy x-ray absorptiometry 5.
- Treatment options for osteopenia include correction of calcium and vitamin D deficiency, walking 3 to 5 miles a week, and pharmaceutical agents such as hormone replacement therapy, selective estrogen receptor modulator therapy, and anti-resorptive therapy 4.
- In some cases, anti-osteoporotic drug treatment may be advocated for individuals with osteopenia who have a high fracture risk, such as those with prevalent vertebral fractures or chronic glucocorticoid use 6.