Osteopenia isn't a disease, and it doesn't mean that you are in immediate danger of breaking a hip or other bone. But having osteopenia means your bones are weaker, more porous and at greater risk of fracture.
Ordinary x-rays don't detect bone loss until over 30% of bone has been lost. Bone mineral density (BMD) tests detect loss sooner. Usually done by means of dual-energy x-ray absorptiometry (DEXA) scans, results are often given as a "T-score".
A T-score compares your bone density to the average density for a person of your gender who is between the ages of 25 and 35-—when bone density is at its peak.
A score between +1 and -1 is normal, a score between -1 and -2.5 is considered osteopenia and a score lower than -2.5 is considered osteoporosis.
If a woman has a BMD test that reveals osteopenia, she may assume that she needs medication to strengthen her bones and reduce her fracture risk.
Bone density is only one indicator of fracture risk. Other factors that influence your vulnerability to fracture include:
- Body mass index (a measure of weight in relation to height)
- Cigarette smoking (1.5-2 times higher)
- More than two alcoholic drinks per day (1.5-2 times higher)
- Use of oral corticosteroids (2-4 times higher; risk increases with dose)
- Rheumatoid arthritis (2 times higher)
- Type 2 diabetes (1.5-2 times higher)
- Sedentary lifestyle (1.5-2 times higher)
- Impaired vision, which increases the chances of a fall (1.5 times higher)
- Stroke (2-4 times higher)
- History of fracture as an adult
- Evidence of vertebral fracture, or parental history of hip fracture (1.5-2 times higher).
When osteopenia is accompanied by other risk factors, preventive strategies such as the ones listed below are recommended:
- Walking and other weight-bearing exercise can increase bone density in the hip and spine.
- Medication is recommended for post-menopausal women who have had a spinal (vertebral) fracture. Experts do, however, disagree about whether drug therapy is advisable for women with osteopenia.
- Estrogen supplementation and all available osteoporosis drugs improve bone density and significantly reduce the risk of vertebral fractures. But some bisphosphonate medications do not reduce the risk of non-vertebral fractures. Only estrogen therapy has been found to do that among women with osteopenia.
For now, a finding of osteopenia should not be a cause for alarm‚ or an indication that medication is required‚ unless additional factors place you at very high risk of a fracture.