How to Treat Osteopenia

Osteopenia is a condition that describes a lack of mineral density in the bones. ‘Osteo’ means “related to bones”, and ‘penia’, means “to lack or have a deficiency”. 

This condition is essentially the preliminary form of osteoporosis and indicates low bone mineral density (BMD)—the total bone mineral composition of a person’s bones. When osteopenia is present, the body is absorbing bone matter quicker than it’s generating new bone matter. 

Rapid or irregular absorption of bone matter causes weak, brittle, thinning bones that are prone to fractures, breaks, and injuries. 

The Difference Between Osteopenia and Osteoporosis

Osteoporosis is essentially the progressed form of osteopenia. Bone loss and bone degeneration happen at a much quicker rate when osteoporosis is present, as opposed to osteopenia. While a person is susceptible to breaking or fracturing a bone with an osteopenia condition, a person is at a considerably higher risk of injuring a bone with osteoporosis.

About 18 million Americans have osteopenia, but more than 200 million people are estimated to have osteoporosis—and many people don’t even know it! (Both osteopenia and osteoporosis don’t necessarily show symptoms until they experience bone fractures or breaks. More than half of these injuries are painless, and go unnoticed!)

How to Identify Osteopenia

To determine whether a person’s bone density is within a healthy range, a person may complete a bone density test. This test will produce a “T-Score”, which identifies the standard deviation, or difference, between your bone mass and the bone mass of a healthy person. 

• A T-score of -1.0 or higher indicates normal bone density. 
• A T-Score score between -1.0 and -2.5 indicates low bone density—osteopenia.
• A T-score of -2.5 or less indicates porous bone that is highly susceptible to fractures—osteoporosis.

Who is affected by osteopenia?

• People who are over the age of 50 are at a higher risk of developing osteopenia. While it is rare for younger people to have osteopenia, there is a ‘juvenile osteopenia’ that affects children between the ages of 8 and 14. 

• People who have a family history of osteopenia are also at a greater risk of developing this condition. People who have naturally smaller bones, specifically Caucasian and Asian women, are at a higher risk of developing osteopenia. 

• The National Osteoporosis Foundation (NOF) says that women over the age of 65, men over the over of 70, women who are post-menopausal, people who have fractured or injured a bone after the age of 50, and people who have rheumatoid arthritis are at a higher risk of being affected by osteopenia. 

Though osteoporosis is considered the more severe form of osteopenia, osteopenia can be just as dangerous as osteoporosis when combined with other risk factors, such as smoking, a low-calcium diet, lack of vitamin D, hormonal changes due to age (especially menopause), and the presence of autoimmune conditions, such as rheumatoid arthritis.

When should a person be treated for osteopenia?

Whether a person should be treated for osteopenia or not depends on a few factors, including sex, age, overall quality of health, and bone density levels. It’s difficult to determine whether a person should be treated for osteopenia without an assessment from an experienced rheumatologist, like Dr. Maria Farooq. 

People who are experiencing serious symptoms of osteopenia, like back pain and poor posture, should be treated for this condition. People who have fractured a bone, have had cancer (especially breast cancer or prostate cancer), or have a condition that places them at a higher risk of falling (like epilepsy or other seizure disorders), should be treated for osteopenia. 

When treatment is completed during the earliest stages of osteopenia, it’s possible to slow the progression of this condition or stop its progression altogether. 

If you believe you may be experiencing symptoms of osteopenia, it’s important that you schedule an appointment at our UCF Rheumatology Services department so we can assess your condition, and discuss potential treatments if necessary. The earlier we can detect osteopenia, the greater our chances are of preventing future bone loss.

Symptoms of Osteopenia

Osteopenia does not have any apparent symptoms. Without undergoing an x-ray or test to determine bone density levels, it can be difficult to tell whether this condition is present.

• Bones fracture easily: A person who has osteopenia may fracture bones very easily, as bone density is low, causing bones to be considerably more weak or thin. (These recurring fractures make a person more susceptible to the progression of osteopenia.) Some bone fractures aren’t painful, and many people with osteopenia fracture their bones without even realizing it!  
• Back pain: Back pain is common in people who have osteopenia because the spine loses its bone density, which makes it more difficult to support the body. Without strong spine support, the body struggles to hold itself up to walk or to sit in an upright position.
• Height loss and stooped posture: As the bones lose density, it becomes easier for the spine to break or fracture. Many people aren’t aware of these breaks or fractures, because 66% of them are painless! These breaks and fractures can cause a stooped posture and gradual height loss, as the spine starts to curve when it’s not supporting the body properly. 

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How does osteopenia inhibit regular activity?

Osteopenia is considered a chronic condition, but it affects everyone differently. While some people with osteopenia may struggle to complete daily tasks without experiencing intense back pain or injuring a bone, other people don’t even realize they have this condition. 

This condition typically goes unnoticed until it progresses and causes apparent problems. As osteopenia progresses, a person may struggle to complete physical tasks, stand for periods of time, and hold the body upright. This can limit a person’s ability to work, drive, and exercise, which can make daily life considerably more difficult. 

If osteopenia progresses to osteoporosis, it’s important to alter your lifestyle to avoid damaging your bones further. People with osteoporosis must be cautious of falling (avoiding icy or slippery walkways, wearing supportive shoes), must mitigate unhealthy habits (drinking alcohol, smoking tobacco), and must commit to a healthy lifestyle (eating nutrient-dense food, limiting sodium intake).

How to Treat Osteopenia

There are various treatment methods (medications, hormone replacement therapy, healthy lifestyle changes) that are commonly used to protect bone mass, slow the progression of osteopenia, alleviate related symptoms, and prevent the development of osteoporosis. 

Medications

Bisphosphonates are the most common medications prescribed to prevent osteopenia. These medications work to curb the body’s natural process of breaking down bone. Because osteopenia is caused by a rapid loss of bone that surpasses the generation of bone, bisphosphonates are effective measures for preventing osteopenia or slowing down its progression. 

Common bisphosphonate medications include alendronic acid (Fosamax), ibandronic acid (Boniva), risedronic acid (Actonel), and zoledronic acid (Reclast), and are typically taken or injected anywhere from once a week to once a month. 

Other medications for osteopenia include Selective Estrogen Receptor Modulators (SERMS) and denosumab. SERMS are used in post-menopausal women to disrupt estrogen activity, which prevents further bone loss. 

Denosumab medications are typically used for people who have cancer. These medications consist of monoclonal antibodies that inhibit the production of osteoclasts (the cells that cause the bones to degenerate). 

Calcitonin is an artificially-replicated hormone that alters the body’s process for reabsorbing the bone. This medication also helps to regulate bone metabolism, which decreases the rate of bone loss and balances the rate of bone regeneration. Calcitonin can be used as a nasal spray or as an injection.

*Side Effects of Osteopenia Medications: 

Bisphosphonate medications that are ingested orally can cause heartburn and esophageal irritation. Medications that are injected can cause flu-like symptoms. Common side effects also include abdominal pain, arthralgia, and ostealgia.

Selective Estrogen Receptor Modulators (SERMS) have an estrogen-like effect on the body, but they are not considered a hormonal replacement therapy method. These medications can cause hot flashes, excessive sweating, and joint pain.

Denosumab medications can cause flu-like symptoms, irritable bowel, bladder infections, muscle and back pain, and an increased risk of osteonecrosis of the jaw (exposure of the jaw bone due to a lack of blood flow).

Calcitonin has been known to cause nausea, abdominal pain, diarrhea, vomiting, as well as swelling and redness at the injection site. 

Hormone Replacement Therapy

Hormone replacement therapy (HRT), also known as menopausal hormone therapy and postmenopausal hormone therapy, is a medication that contains female hormones. This treatment method is often used to alleviate unpleasant symptoms associated with menopause. Because menopausal women are at a higher risk of developing osteopenia and studies have shown that estrogen can prevent bone loss in women, HRT was once considered a cure-all for osteoporosis and osteopenia in women. 

As studies on HRT have shown severe side effects, like increased risk of heart disease, breast cancer, and strokes, this method is considered a very risky treatment option. 

The side effects associated with osteopenia medications are considerable. Over the years, more side effects have come to light, and the question of whether these treatments are worth it has been up for debate. Whether the side effects are worth the treatment is up to you and your doctor.

It’s important to weigh your treatment options, educate yourself on the side effects, and consider the severity of your condition before beginning a new medication.

Healthy Lifestyle Changes

Living a healthy lifestyle is key to preventing osteopenia from developing, or slowing its progression to prevent osteoporosis. 

• Eat a balanced diet with plenty of vitamin D
• Limit alcohol intake
• Exercise regularly with weight-bearing exercises (lifting weights, hiking, jogging, climbing stairs)

For people who have osteopenia, there are ways to manage this condition and lessen the symptoms.

• Increase calcium and vitamin D intake
• Do not smoke
• Limit alcohol intake
• Limit caffeine intake
• Take measures to prevent falling (with low bone density, falls can result in fractured or broken bones fairly easily)

We advise you to take preventative measures no matter your age or number of risk factors! It’s a great idea to increase your nutrient intake, get more exercise, and limit unhealthy habits, regardless of your physical vulnerability. 

The best treatment method for osteopenia will vary for each person. Depending on the severity of the condition, your age, sex, and lifestyle habits, our rheumatologist, Dr. Maria Farooq, will help you to create a treatment plan that suits you, supports strong bones, and minimizes your symptoms.