Bone health: diagnosing and treating osteopenia

It’s a bone condition that’s hard to spot, but it can be treated. Professor Kerryn Phelps investigates osteopenia, its causes and how to deal with a diagnosis.

As with other hidden health issues, you may only think about your bones when something goes wrong. With osteoporosis, where bones become thin, weak and vulnerable to fracture, the first sign may be a fracture.

In osteopenia, the bone’s mineral and protein components are reduced so there is a lower bone density than the normal, ideal density, but not low enough for a diagnosis of osteoporosis. There are no symptoms of osteopenia so a diagnosis may be made when X-rays are done for injuries or medical conditions, or when a bone density scan is arranged. Osteopenia may develop into osteoporosis, but this is not inevitable. Diagnosing osteopenia gives you the chance to protect your bones from further loss.

What causes osteopenia?

Risk factors include: l Age: over 70, or men over 60 and women over 50 with other risk factors. l Genetics: a family history. l Alcohol (more than two drinks per day) particularly during adolescence and as a young adult. l Smoking. l Too much caffeine. l Lack of weight-bearing exercise, or excessive exercise. l Early menopause. l Excessive dieting and low body weight (below 50kg). l Poor nutrition. l A gut problem causing malabsorption of nutrients needed for bone building. l More than six months’ use of corticosteroid medication (for example, for arthritis or autoimmune diseases). l Other long-term medications, including some antidepressants and acid-lowering medications. l Adjunctive hormone treatments for breast cancer. l Overactive thyroid or excessive thyroid medication.

By being aware of these risk factors, you can adjust your lifestyle habits to protect your bone health.

Reducing fracture risk

The earlier osteopenia is diagnosed, the better the chance of reducing the risk of fractures. The higher risk of fracture in people with osteoporosis does not apply to osteopenia, but osteopenia is a signal osteoporosis could develop.

After the diagnosis

Your doctor will look for treatable underlying causes of bone density loss. You’ll be encouraged to exercise, especially weight-bearing exercise, stop smoking, minimise alcohol, optimise your nutrition and take supplements. Your doctor will recommend monitoring, usually a bi-annual bone density scan.

Medication

Hormone replacement around menopause can reduce bone loss rates, especially if you have osteopenia.

This has to be balanced against other hormone therapy risks, such as breast cancer. Osteoporosis medications don’t apply to osteopenia.