What are osteopenia and osteoporosis?
Osteopenia and osteoporosis are two related conditions characterized by lower than normal bone densities. Anyone can have osteopenia and osteoporosis, although it most commonly afflicts post-menopausal women. Reduced bone density in patients presents a greater risk for bone fracture. Technically speaking, osteopenia and osteoporosis are manifestations of the same condition, but to different degrees. Osteopenia, the lesser condition, is defined as having one standard deviation below normal bone density. A standard deviation is a unit of measurement used in statistics and it represents about the 16th percentile and below. Osteoporosis is defined as having 2.5 standard deviations or more below normal bone density, placing it at the 2nd percentile and below. There has been some controversy regarding osteopenia and its status as a genuine condition. Some doctors and epidemiologists view osteopenia as simply a precursor to osteoporosis and hold that the diagnosis has no real significance other than to identify those who are most at risk for later developing osteoporosis. Other doctors believe that osteopenia is a genuine condition that while less serious than osteoporosis develops in a far greater percentage of patients and still represents a treatable condition. Since diagnoses and treatments of the two conditions are very similar, they are usually grouped together.
- What is osteopenia?
- Osteoporosis in women
- Bone thinning in women
- National Osteoporosis Foundation
- Frequently asked questions on osteoporosis
Causes
Both osteopenia and osteoporosis are caused by an imbalance in the activities of two different types of bone cells: osteoblasts and osteoclasts. Osteoblasts are bone cells that form bone, while osteoclasts are bone cells that break bone down and absorb its minerals back into the blood steam. Normally, there is a balance between the two. Osteopenia and osteoporosis develop when osteoclast activity is stronger than that of osteoblasts and as a result bone density lowers over time. Different factors can lead to such an imbalance, including lowered estrogen levels and calcium and Vitamin D deficiencies. Over time, however, all adults will lose bone density to some degree as they age, although women will on average lose more than men.
- Bone mineral density tests
- Types of bone cells
- Bone development
- What causes osteoporosis?
- List of causes of osteoporosis
Symptoms
Oddly enough, osteopenia and osteoporosis have no visible symptoms. As such, it’s often referred to as a “silent disease.” Most people who have either condition don’t realize it until they have been diagnosed with it or until they crack or break a bone. The characteristic symptom, then, of either condition is a greater risk for bone fracture. The types of bone fractures that patients with osteopenia and osteoporosis experience are ones that usually would not occur in healthy patients with normal bone densities. Such bone fractures are commonly referred to as osteoporotic fractures or fragility fractures. Because the elderly lose mobility and balance as they age, their greater risk for falling makes lowered bone densities a very serious condition. Broken wrists and hips are very common as a result of minor slips and falls.
- Signs and symptoms of osteoporosis
- Osteoporosis symptoms
- Osteoporosis: Symptoms and types
- Risk Factors for osteoporosis
- Symptoms of osteoporosis
Diagnoses
Although there are some bloods tests that can confirm either condition, the most common method to diagnose them is by using dual energy x-ray absorptiometry (DEXA). This form of radiography allows doctors to determine whether a patient has reduced bone density or not. The results of the test are expressed in what are called T-Scores. A normal T-Score is defined as having the bone density of healthy, normal white female at the age of 30. Having a T-Score one standard deviation or below normal leads to a default diagnosis of osteopenia or osteoporosis. In most cases, doctors would perform certain follow-up tests to ensure that the reduced bone density isn’t caused by some other underlying disease or condition. Certain types of bone and plasma cell cancer, among others, can reduce bone density on their own and need to be eliminated as root causes of the condition.
- Diagnosing osteoporosis
- What is DEXA?
- Screening for osteoporosis
- Bone density tests
- Osteoporosis: Evaluate your risk
Treatments
Treatments for osteopenia and osteoporosis fall into one of three categories: those that modify lifestyle, those that lower the rate of bone resorption, and those that increase bone production.
Lifestyle changes
Regardless of medication, the most important aspect of treatment will be certain changes to a patient’s lifestyle. This includes, but isn’t limited to:
- Better nutrition, especially the consumption of calcium and Vitamin D
- Exercise to maintain or even increase bone densities
- Elimination of smoking and the reduction of alcohol consumption
- Reconfiguration of the home to reduce the chance of slips and falls
Bone Resorption
Patients with osteopenia and osteoporosis can take medications that slow down the activity of osteoclasts and thus lower the rate at which bone is broken down and absorbed back into the bloodstream. Examples include bisphosphonates and raloxifene.
Bone production
Patients with either condition can also take medications that increase the activity of osteoblasts and thus speed up the rate at which bone is created. Examples include teriparatide and sodium fluoride.
