Symptoms
How do I know if I have Osteopenia?
Osteopenia has no symptoms. You notice no pain or change as the bone becomes thinner, although the risk of breaking a bone increases as the bone becomes less dense.
The only way to find out is to have a bone mineral density (BMD) test, the same non-invasive diagnostic test used for osteoporosis. A bone mineral density (BMD) test compares your bone density with the peak bone density of a young, healthy woman.
While pharmacologic treatment is rarely recommended for a woman with osteopenia, there are steps that women with this diagnosis can take to reduce their risk of bone fractures and progression to osteoporosis. Modifying behavioral risk factors is key: stop smoking, increase weight-bearing exercise, increase dietary calcium and vitamin D. Most importantly, ask your doctor what kind of follow-up you should have, particularly when you should have a follow-up BMD test.
Every postmenopausal woman should have the screening by age 65. Depending on risk factors, your doctor could recommend the test earlier.
How to treat Osteopenia? What can I do?
Treatment of osteopenia depends on age and the presence of other risk factors for fractures.
If the BMD indicates osteopenia, you'll want to talk to your doctor about ways to halt bone loss before it progresses to osteoporosis. Ways for postmenopausal women to keep bones healthy include:
Consume 1,200 to 1,500 milligrams of elemental calcium and 400 to 600 international units of vitamin D every day.
If you smoke, quit.
If you're inactive, get moving. Daily weight-bearing exercises and strength training help build bones.
Talk to your doctor about other medication options, especially if you're at increased risk of osteoporosis. Risk factors include menopause before age 40, family history of osteoporosis, smoking, white or Asian heritage, oral steroid use and several other clinical factors.
Premenopausal women
In healthy women who still have regular menstrual periods, prescription medications should not be used for osteopenia, because the long-term safety and effectiveness has never been demonstrated. Women should eat a healthy diet, maintain a sturdy weight, get exercise, and not smoke. Women with chronic diseases or infrequent periods may be at a higher risk and they should consult their physicians.
Early postmenopausal women
For healthy women between 50 and 60, osteopenia is not an immediate threat, but if no preventive medications are given, women will develop osteoporosis as they get older. Calcium, vitamin D and exercise are important but probably not enough to prevent osteoporosis in later life.
Estrogen is also a good choice for women with menopausal symptoms. Calcitonin (Miacalcin) has been used for many years and is a safe medication, but is not quite as effective, so it is an alternative. Raloxifene (Evista) acts like estrogen on the bone, but we don't know long-term effects, and it does not help with hot flashes.
Once women are beyond age 60, hot flashes are usually not so much of a problem and raloxifene can be used in women concerned about breast cancer. Studies about prevention of breast cancer are currently underway. Alendronate (Fosamax) or risedronate (Actonel) prevent bone loss, but the long-term safety of these medicines is unknown, and the decrease in bone formation rate is 95%.
Older postmenopausal women
Those women who have lived over 80 years had have osteopenia are above average! If they are healthy and without fractures they don't need prescription medication for their bones. They should eat enough protein and calcium, take vitamin D, maintain a sturdy weight, get exercise, and not smoke. Women above age 65 should need prescription medications only if they have "osteoporosis" or if they have other medical complications placing them at high risk.
Women ages 60 to 64 should be screened if they also have at least one risk factor in addition to menopause. Risk factors include:
• Being white (Caucasian) or, to a lesser degree, Asian.
• A family history of osteoporosis.
• Being thin.
• Long-term use of corticosteroids, such as prednisone or hydrocortisone for inflammatory conditions, or anticonvulsants, such as carbamazepine (Tegretol), phenytoin (Dilantin), or gabapentin (Neurontin) for pain or seizures.
• Eating disorders or diseases that affect the absorption of nutrients from food.
• Being inactive or bedridden for a long period.
• Smoking.
• Drinking excessive amounts of alcohol or beverages containing caffeine.
• Having a diet low in calcium or vitamin D.
Many men don't think they are at risk for osteopenia or osteoporosis, since these are commonly considered to be conditions of older women. Because men have a higher peak bone mineral density than women at middle age, osteopenia and osteoporosis tend to happen at an older age in men. However, aside from the hormonal change in women as they go through menopause, the risk factors of osteopenia are risks for men as well as women.
Men are also at risk if they have low levels of the hormone testosterone.
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