Low bone density, osteopenia, is the stage between normal bones and osteoporosis. When osteopenia progresses, your bone density scan may drift into the category of osteoporosis, a further decrease in bone mass. Peak bone mass in women occurs around age 30, so osteopenia and osteoporosis occur because we are reabsorbing bone while not forming new bone, which results in brittle bones. Weaker bones are more likely to fracture, and therein lies the problem of osteoporosis. The 30-day mortality after a hip fracture is almost 9%. Knowing this, my patients ask an excellent question several times a week “If I have osteopenia, what can I do now to prevent further bone loss?” Let’s take a look.
How to find out if you have Osteopenia
The answer is a bone density scan. Screening for osteopenia and osteoporosis is easy and involves a painless DEXA (dual-energy x-ray absorptiometry) /bone density scan, which your doctor can order. The T-score you receive compares your bone density to a young, healthy adult, and that result places you into one of three categories: normal, osteopenia, or osteoporosis. Recommendations vary, but women 65 and older should have a DEXA scan to look at their bone density. You may have one younger than 65 if you have risk factors, which include
- current cigarette smoking
- excessive alcohol use
- low body weight
- a parent with a hip fracture
- previous glucocorticoid use (this is something like prednisone)
If you haven’t gone through menopause, for the most part, you don’t need to be screened yet.
How to prevent further bone loss if you have Osteopenia
Bones like impact to grow. Here’s an example: a large study in 2015 among premenopausal women aged 25 to 50 years in 20 cities in the United States showed impressive benefits of impact, specifically jumping. Hear me out. Women assigned to do ten or twenty jumps with 30 seconds rest between jumps, twice daily for 16 weeks, had improved hip bone density measured by DEXA scan. The jump twenty group had significantly greater gains over non-jumpers. If you can’t jump or are unable to do impact exercise, 30 minutes of any physical activity will help.
Calcium and Vitamin D supplements…..but it’s tricky
Adequate nutrition is essential for bones, particularly calcium and vitamin D. However, the overall effect of calcium or vitamin D supplements alone on fracture risk is uncertain. There is no data to show that calcium alone or vitamin D alone can reduce your risk of vertebral or hip fractures. Vitamin D supplements, if you are deficient, are a good thing. On the other hand, calcium supplements have recently gotten into hot water and should not be taken without vitamin D in them and never more than 1500 mg a day because of a potential link to a heart attack.
Dietary Calcium and Osteopenia.
Current recommendations suggest calcium and Vitamin D come from your diet instead of supplements when you can. A total of 1200 mg of calcium (total from diet + supplement) and 800-1000 international units (IUs) of Vitamin D daily is recommended for postmenopausal women with osteopenia or osteoporosis. A rough estimation of dietary calcium intake multiplies the number of dairy servings you eat or drink by 300 mg. One serving is 8 oz of milk or yogurt or 1 ounce of hard cheese, for example. Dark green vegetables, nuts, bread, and cereals supply 100 to 200 mg of calcium daily. Dairy products have the most calcium, and the absorption is better than with veggies and nuts.
Is Osteopenia treated with medications?
No, not typically. While there are clear benefits (lower fracture risk) for bisphosphonate medications in osteoporosis, the same is not true with osteopenia. However, osteopenic women 65 years of age or older who are at high risk for a fracture may discuss the benefits, harms, and costs of medications with their doctor. Estrogen replacement therapy, though it helps bone density, should not be used for that purpose only.
I am a Clinical Associate Professor of Medicine at the Keck School of Medicine of USC and a board-certified Internal Medicine physician. For 20 years I’ve had an active private practice in general internal medicine currently at The Doctors of USC Beverly Hills. I am lucky to spend part of my time as the attending physician for medical students and residents during their rotations at LAC+USC Medical Center. I’ve been a medical advisor on leading health social networking sites including Dailystrength.org and Sharecare and currently serve as the medical advisor and blogger for GoodRx.com, a prescription drug price comparison website, and GoodRx care powered by Hey Doctor.
My philosophy of care centers around seeing things we can see coming, and nailing them head-on. I appreciate the idea of sharing power and responsibility for the choices one makes for prevention, treatment, and investigation into medical problems. My hope is to write blog posts to empower patients to navigate their own health by laying out the ways that medicine can guide you with strategies to investigate, prevent, and treat some common medical issues, big and small.
I have appeared on The Doctors, Fox Sports West, The Ricki Lake Show, as well as many local news outlets and have been featured in numerous online and print publications. I am a fellow of the American College of Physicians and honored to be named “Top Doctor” in Los Angeles and Pasadena Magazine for years.