Half of all Americans over age 50 will tell they’ve lost some of their Bone density (Osteopenia). It’s worrisome when it happens to you, but it’s also a wake-up call to take better care of your bones.

We wouldn’t even be able to sit upright without him, so ironically, most of us don’t think much (let alone thank you!) of our bones. We tend to take our internal infrastructure for granted until we receive an alarm. If you have told that your Bone Density is low (also known as osteopenia), you get it. Instead of panicking, relaxing, and reading. We explore beyond weak bones and present strategies to strengthen them.

What is Osteopenia?

Let’s start right at the very start—in utero. When you’re a fetus, your bones start to shape, and they continue to do so until sometime in your 20’s.

What are bones made of? At first, mainly cartilage (a resilient and smooth elastic tissue). The bones are soft and flexible when you’re an infant and combine with other bones (fun fact: you’re born with nearly 100 more bones than you have when you’re adult).

As you get older, calcium phosphate replaces the cartilage, a mineral that makes them durable. The bones also made of collagen, a protein that gives a little flexibility without cracking. Bones are composed of three cell types:

• Osteoblasts, the cells forming bones
• Osteoclasts, bone-depleting cells (also known as bone resorption)
• Osteocytes, old osteoblasts trapped in a matrix of bones

Osteoblasts regularly make new bones, while osteoclasts break down old bones and release calcium into your blood and tissue, a process called remodeling.

What’s Calcium Got to Do With Bone Density?

The mineral density of your bone measures the calcium content in your bones. The higher the mineral content, the denser your bones are and the stronger. The less the amount of minerals, the weaker, the more porous (possessing holes), and the more brittle the bones are.

What do we mean by brittle? Think glass. It’s hard, but probably breaking or shattering when you drop it. The bone that lacks minerals becomes delicate inside, cracking into pieces from a little pressure.

In general, when a person diagnosed with Low Bone Density or lack of bone, this means that he has lost some bone density, but not like a person with osteoporosis, a disease of the bone that occurs when the bone weakens, is thin and becomes very fragile. It is prone to fracture (the medical term for bone fracture). Yes, like a glass.

What Are the Risk Factors for Osteopenia?

So, how do you get low bone density or osteopenia? By the age of thirty, you will have reached the peak of bone mass, which is the strongest bone in your life. If you have a childhood disease that affects bone formation or causes malnutrition (for example, celiac disease or anorexia), the maximum bone mass may not be as high as possible.

Most people do not have low bone density until middle age when they naturally start to lose bone mass. But some factors can cause bone erosion early or speed up its loss after 50 years. These include:

• Being Born a Woman: anatomy places women at a higher risk of low bone density. Female bones are smaller and naturally thinner than men’s, so women have a lower peak bone mass. So as soon as you start to lose bone as you age, there is little to lose. Research has shown that women 50 and older are more likely to have osteoporosis than men.
• Smaller Stature: being a slim, small, “small-boned” woman is linked to lower bone density and a higher risk of osteoporosis.
• Being Caucasian or Asian: these groups tend to have much higher bone density than Latinos or African Americans. More than half of the white postmenopausal women have this condition.
• Genetics: The quality of your bones are passed on by our parents. Up to 80% of the height of your bone mass is said to be determined by genetics.
• Underlying conditions: Several diseases can interfere with healthy bone growth by affecting how your body absorbs calcium and other nutrients. Examples include:

1. Undiagnosed celiac disease (unless treated with a change in diet)
2. Hyperthyroidisation
3. Diabetes Diagnosis
4. Arthritis rheumatoid
5. Eating conditions like anorexia nervosa or bulimia

• Rare Bone Diseases: Bone disease can undoubtedly affect your bone density, like the ones below:

1. Osteomalacia (softening of the bones due to a severe deficiency of vitamin D)
2. Paget ‘s disease (interfering with the natural remodeling of the bone, leaving bones fragile)
3. An imperfect osteogenesis-a genetic disease that affects healthy bone formation

• Medications: Some Medications can speed bone loss. The biggies are:

1. Steroids (usage over the long term)
2. Chemotherapy and other medications for cancer
3. Heartburn drugs (Prevacid, Nexium) classified as Proton pump inhibitors.
4. Thyroid hormone (surplus)

• Diet: a diet that is chronically low in calcium and vitamin D — which helps your body absorb calcium — may affect bone density. Skimping on either nutrient during the first few decades of your life can cause you to have low peak bone mass. And failing to get enough calcium and vitamin D will cause your bone to break down more rapidly as you age. Practicing a safe and balanced eating lifestyle is best for your bones. Three circumstances also can make you deficient in many of the nutrients and vitamins required for healthy bones:

1. To have an eating disorder
2. Extreme diet
3. Surgery of weight loss

How do you know that your body is low in calcium? Tell your doctor if you have any of these symptoms:

1. Tingling (especially in your lips, tongue, fingers, and legs)
2. Muscle spasms and pain
3. Abnormal rhythms of the heart

• Ebbing Hormones: Yup, the hormones also influence the bones. Loss of estrogen that comes with menopause can worsen bone loss, and going through this early life transition (say, in your 40s) will increase the risk of osteopenia. Low levels of testosterone in men are also linked to lower bone density.
• Excess Alcohol: Extreme, heavy drinking (defined as more than two drinks a night) is correlated with lower bone density.
• Not Enough Exercise (or Too Much!): Weight-bearing workouts such as walking, dancing, and hiking, as well as strength training, always put enough tension on the bones to promote bone development. This means maintaining your optimum bone mass and holding stable bone mass as you age. On the flip side, excessive exercise isn’t good for a body. Skilled female athletes are especially at risk for the female triad: disruption of their menstrual cycle,low-calorie intake, and low mineral bone density.

How Is Osteopenia Diagnosed?

There are no obvious symptoms that weakening of bones unless you break one. Osteopenia is most commonly found during a routine bone density scan, or densitometry (DXA or DEXA scan). Bone density scans are generally given to women aged 65 and men aged 70 but your doctor or gynecologist may suggest one earlier if you have the above mentioned low bone density risk factors or a history of bone fractures.

How Does a Bone Density Scan Work?

This imaging exam is like an x-ray that measures the mineral content of your bones. The higher your mineral content, the stronger your bones are. The lower the mineral content, the weaker. Results are given in what is called a T-score, a number that tells doctors how your bones stack up to 30 years of age at the peak bone mass.

• Above-1.0 is considered to be normal
• -1.0 to-2.4 is a low bone density or osteopenia
• -2.5 and below indicate more severe osteoporosis, which means that your bones are brittle and at higher risk of fracture.

Your danger of fracture increases as your T-score dips: a 50-year-old woman with a T-score of-1,0 has a 16 % chance of hip fracture, while a-2,5 increases the risk to 33 %, according to research in the Journal of the American Medical Association.

You may also receive a Z-score that compares your bone density to persons of your age and gender. Think of this as an age test for your bones. Z-scores tend to give to those under the age of 50, for whom low bone density is not the norm. It helps doctors decide if you have an underlying condition that affects your bone health.

Your doctor may use one more test, especially if you are a woman over 50 years of age: the Fracture Risk Assessment Tool (FRAX). It determines how likely you are to be bone fractured in the next ten years. Even if you don’t have severe osteoporosis, you may have a high FRAX score. Will be used by your doctor to determine your treatment.

So, for low-density bone, which sort of doctor will you see? There is no singular specialist for osteopenia and osteoporosis. Some of the following types of documents should be able to treat you:

• General practitioners
• Endocrinologists
• Gynecologists
• Rheumatologists
• Physiatrists
• Orthopedics
• Doctors in Geriatric Medicine

What is Osteopenia Treatment?

Most cases of osteopenia do not require medication. Little changes to your lifestyle and diet can make a long way to beefing up your bones, as your doctor will probably tell you. Start right here:

• Weight-bearing exercises: Weight-bearing exercises that require you to support your body weight (walking, jogging, dancing, etc.) and resistance training stimulate the formation of new bones, which is why osteopenia and osteoporosis recommended. If your bone density is very low, you might want to avoid exercises with high impacts such as running or other falling risks. Non-weight bearing activities such as swimming and cycling are A-okay, as long as in weight-bearing training, you are still squeezing.
• Changes in diet: Boosting your levels of calcium and vitamin D can help slow bone deterioration.

Calcium recommendation is 1200 mg for women over 50 and 1000 mg for men. Ideally, it would help if you took your daily dose through your diet. Calcium-rich foods shall include:

1. Dairy products such as yogurt, milk, and cheese
2. Dark leafy greens, such as kale and collard greens
3. Sardines and Bone with Salmon
4. Strengthened foods such as orange juice and cereals

Vitamin D comes from sunlight as well as food such as:

1. Fats fish such as salmon, tuna and mackerel
2. Enhanced milk
3. If you don’t think you’re getting enough D through your diet, a supplement can fill the gap.

Other vitamins and nutrients that are beneficial to bone health are:

1. Vitamin C (citrus fruit, red peppers, strawberries)
2. Vitamin K (kale, spinach)
3. Potassium (potatoes, raisins, and bananas)
4. Magnesium (sweet potatoes, tomatoes, artichoke hearts)

A Mediterranean-style diet — lean proteins, olive oil, foods rich in omega fatty acids — is also linked to a healthier bone density. Some studies have linked caffeine in coffee and colas to low bone density, but the evidence has not been conclusive. Experts say drink in moderation to be safe.

What drugs are prescribed for osteopenia?

If your FRAX score puts you at a high risk of fracture, or if you have already had a fracture, your doctor may prescribe medication to slow your bone loss. The goal is to prevent osteopenia from progressing to osteoporosis.

Well, what kind of med? Bisphosphonates are FDA approved for the prevention of osteoporosis in women with osteopenia (as well as for the treatment of osteoporosis). These drugs slow down the osteoclasts, the cells that break down the bone. Most of them are oral tablets taken weekly or monthly. Examples of this are:

• Fosamax (alendronate), taken by mouth
• Boniva (ibandronate), taken by mouth
• Actonel (risedronate), taken by mouth
• Zometa, Reclast, and Aclasta (zoledronic acid or zoledronate) taken via IV

Taking medications, if prescribed by your doctor, can stave off further bone damage and breaks that it tends to cause. According to one study published in The New England Journal of Medicine, giving zoledronate every 18 months for six years lowered the risk of hip fracture in women with osteopenia by 37%. The appointment with your doctor is the first step to start treatment to slow down your bone loss — don’t wait to make one!

FREQUENTLY ASKED QUESTIONS
Osteopenia

How do I know if I’ve got a low bone density?
Most of the time, you won’t know until you have a bone density scan (think of X-ray osteoporosis) to determine how strong or weak your bones are. The recommended age for osteoporosis screening is 65 for women and 70 for men. If you have risk factors for osteoporosis, your doctor may want you to have a scan earlier. Of course, a lot of people learn that they have a low bone density more suddenly when they suffer a fracture from something like a stumbling block.

Can I reverse osteopenia?
Total reversal is unlikely, but with lifestyle changes — calcium-rich diet, supplements, weight-bearing exercises, and medications if needed — can strengthen bones to the point that they are at lower risk of fracture. Experts say, is the goal of treatment for osteopenia and osteoporosis.

Does an osteopenia diagnosis mean I’ll eventually have osteoporosis?
Not necessarily that. You have a lower bone mass density than usual, which puts you at a higher risk of osteoporosis, but that doesn’t mean you’re going to get it. Many doctors say that osteopenia is a wake-up call for their patients to pay more attention to their bone health: boost their intake of calcium and vitamin D, start exercising, stop smoking, and drink less alcohol. This plan can stave off the rapid loss of bone and bone fractures that often occur.

What’s bone resorption?
This is the process by which your body breaks down old, mature bones and releases calcium into your tissues and blood. It’s natural and necessary, but when bone resorption starts to outpace new bone formation, you are at risk of developing low bone density and osteoporosis.

Sources:

• Prevalence of Osteopenia in Women: Journal of Clinical Medicine Research. (2017). “Gender Disparities in Osteoporosis.” ncbi.nlm.nih.gov/pmc/articles/PMC5380170/
• Female Triad and Bone Density: Sports Health. (2012). “The Female Triad.” ncbi.nlm.nih.gov/pmc/articles/PMC3435916/
• Osteopenia and Fracture Risk: The Journal American Medical Association. (2001). “Identification and Fracture Outcomes of Undiagnosed Low Bone Mineral Density in Postmenopausal Women: Results From the National Osteoporosis Risk Assessment.” ncbi.nlm.nih.gov/pubmed/11735756
• Zoledronic Acid and Osteopenia: The New England Journal of Medicine. (2018). “Fracture Prevention With Zoledronate Acid in Older Women With Osteopenia.” nejm.org/doi/full/10.1056/NEJMoa1808082