Osteopenia and Healthy Aging

Is Osteopenia an Inevitable Part of Aging?

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Osteopenia is an age-related medical condition in which bone mineral density is lower than usual. But is it an inevitable part of aging? And should you worry about it?

Recently, a colleague (who was diagnosed as having osteopenia) asked me about treatment and medications. I didn’t have the information off the top of my head, but I told her (confidently) “Oh, I’ll just do a few searches on osteopenia and I’ll send you the information.”

For the record, I was very wrong. For some reason, information on osteopenia (which is more and more frequently diagnosed) is really hard to find. Osteopenia usually shows up as a footnote in entries about osteoporosis. So I decided I would just have to write my own article about osteopenia (read more about osteopenia medications and osteopenia prevention).

Diagnosis of Osteopenia

Osteopenia is a “silent” condition. People with osteopenia have no symptoms and the condition is only found through medical testing.

In most people, osteopenia is considered an “early warning” for osteoporosis (which is defined as bone mineral density 2.5 standard deviations less than peak bone mineral density – that’s a fancy way of saying “really low bone mineral density”).

When bone mineral density is between 1 and 2.5 standard deviations less (which is to say low, but not low enough to trigger that osteoporosis diagnosis), then a person is said to have osteopenia.

As it turns out, osteopenia is an incredibly common condition among older adults. A 2010 study reported that a startling 49% of women and 30% of men ages 50 and over had osteopenia at what's called the femoral neck, which is located at the top of the thigh bone. The femoral neck is a common place for hip fractures to occur.

As I said, people with osteopenia are at risk for developing osteoporosis, but there is a good deal of controversy when (or if) treatment for improving bone density should occur in people with osteopenia.

Testing for Osteopenia

Osteopenia (and osteoporosis) can be tested using a variety of techniques. Bone scans (X-ray) can tell the density of bones and there are X-ray machines that are portable and often used in health screenings to look for osteopenia or osteoporosis. Testing is painless and quick.

According to the U.S. Preventive Services Task Forces, bone mineral density screens are recommended for all women aged 65 or older and for women 60 and older if they are:

  • white or Asian
  • have a family history of osteoporosis
  • thin or petite
  • have long-term history of using steroids for treating medical conditions
  • smokers
  • have low vitamin D or calcium

Who Has Osteopenia?

Women, mostly. This is because of rapid bone density loss during the first year or two after menopause (as all those hormones and chemicals in the body reset).

This bone loss often stabilizes after the initial period.

Some estimates say that up to 18 million women have osteopenia (with another 10 million having osteoporosis). Other risk factors for osteopenia are lack of exercise (your bones need some stimulation to stay healthy), smoking, excessive alcohol and long-term use of some medications (like steroids).

Some loss of bone density is normal with aging and osteopenia itself may simply be the normal aging of bones (it doesn’t really pose a problem unless it becomes osteoporosis).

Sources

Looker AC et al. Prevalence and trends in low femur bone density among older US adults: NHANES 2005-2006 compared with NHANES III. Journal of Bone and Mineral Research. 2010 Jan;25(1):64-71.

National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. Feb. 2008. Accessed July 23, 2008.

MedlinePlus Medical Encyclopedia: Osteoporosis

Osteopenia. Sundeep Khosla, M.D., and L. Joseph Melton, III, M.D., M.P.H. New England Journal of Medicine. Volume 356:2293-2300. May 31, 2007.

National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. 2008.

MedlinePlus Medical Encyclopedia: Bone mineral density test.

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