What is Osteopenia?

Think of it as a midpoint between having healthy bones and having osteoporosis.

Osteopenia is when your bones are weaker than normal but not so far gone that they break easily, which is the hallmark of osteoporosis.

Your bones are usually at their densest when you’re about 30. Osteopenia, if it happens at all, usually occurs after age 50. The exact age depends how strong your bones are when you're young. If they're hardy, you may never get osteopenia. If your bones aren't naturally dense, you may get it earlier.

Osteopenia -- or seeing it turn into osteoporosis for that matter -- is not inevitable. Diet, exercise, and sometimes medication can help keep your bones dense and strong for decades.

Who Is Most Likely to Get It?

This condition happens when your body gets rid of more bone than it is creating.

Some people are genetically prone to it, with a family history of the condition. You're also more likely to get it if you're a woman.

Women have lower bone mass than men. Also, women live longer, which means their bones age more, and they usually don't get as much calcium as men.

Calcium is the key to keeping bones healthy. Hormone changes that happen at menopause increase the chance for osteopenia for women, and men with lower testosterone levels have higher odds of getting it.

What Are the Medical Causes?

Sometimes, you may have a medical condition or treatment that can trigger the condition.

Eating disorders, such as anorexia and bulimia, can starve your body of nutrients needed to keep bones strong. Other causes include:

• Untreated celiac disease. People with this condition can damage their small intestine by eating foods with gluten in them.
• An overactive thyroid. Too much thyroid medication can also play a role.
• Chemotherapy. Exposure to radiation can have an effect.
• Certain medications. These include steroids such as hydrocortisone or prednisone and anti-seizure drugs such as carbamazepine (Carbatrol, Tegretol), gabapentin (Gralise, Horizant, Neurontin), or phenytoin (Dilantin, Phenytek).

Are There Lifestyle Causes?

Problems in your diet, lack of exercise, and unhealthy habits can contribute to this condition. Watch out for:

• A lack of calcium or vitamin D
• Not enough exercise, especially strength training
• Smoking
• Too much alcohol

How Is It Diagnosed?

Osteopenia usually doesn't have any symptoms. This makes it hard to diagnose unless you have a bone mineral density test.

The National Osteoporosis Foundation recommends the test if you meet any of the following:

• You’re a woman 65 or older
• You’re a postmenopausal woman 50 or older
• You’re a woman at the age of menopause and have a high chance for breaking bones due to presence of other risk factors
• You’re a woman who has already been through menopause, younger than 65, and have other risk factors that give you a higher chance of osteopenia
• You’re a man older than 65 with risk factors
• You break a bone after age 50 without significant trauma (known as fragility fracture)

The test is painless and fast. It estimates how dense or thick your bones are by using X-rays.

Often, the first sign your bones are getting weak is a break. Many people have a fracture or a series of fractures in their spine and don’t even know it. See your doctor if you have symptoms of a spinal fracture, which include:

• Sudden, severe back pain
• Back pain that gets worse when standing or walking, but gets a bit better when you lie down
• Back pain when bending or twisting
• Loss of height
• Curved or stooped shape to your spine

Prevention and Treatment

It's never too early to take steps to prevent osteopenia. Talk with your doctor about an exercise plan that’s right for you. Eat the right kinds of food.

But even if you already have osteopenia, it's not too late for you to stop it from turning into osteoporosis with these strategies:

Get enough calcium and vitamin D: This may be the most important thing you can do for your bones at any stage of life. You can get calcium in:

• Dairy products such as yogurt, cheese, and milk (go for low-fat or nonfat varieties)
• Spinach and broccoli
• Dried beans
• Salmon

Vitamin D, which helps your body absorb calcium, can be found in eggs and in oily fish such as salmon and sardines.

Some foods, including orange juice, cereal, and bread, have added calcium and vitamin D.

It's also a good idea to spend 10 to 15 minutes in the sun twice a week because this helps convert inactive Vitamin D to active form.

If your doctor doesn't think you're getting enough calcium and vitamin D, they may suggest that you take a supplement. Guidelines for vitamin D intake exist for different ages and situations such as pregnancy.

Weight lifting: You can do regular, weight-bearing exercises to prevent or slow osteopenia. Talk with your doctor before you start a strength-training program.

Lifestyle changes: If you smoke, try to quit. Cut down on carbonated drinks and alcohol.

Medications

Prescription medications are sometimes used to treat osteopenia if your bones are starting to get weak.

Medicines also used to treat osteoporosis might be prescribed. These include:

• alendronate (Binosto, Fosamax)
• ibandronate (Boniva)
• raloxifene (Evista)
• risedronate (Actonel, Atelvia)
• zoledronic acid (Reclast, Zometa)

You might have side effects such as digestive problems and bone and joint pain. They might also make you feel tired.

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