Osteopenia

Original Editors

Top Contributors - Hamelryck Sascha, Rotimi Alao and Claire Knott  

Search Strategy

Information was found by searching online databases, Pubmed and pedro where consulted. Additional information was found by searching google and consulting topic related sites like medline and spineuniverse.
Most succesful keywords where: Osteopenia, physical therapy, high impact exercise.

 Definition/Description

Osteopenia is a condition characterised by the loss of bone mineral density (BMD). However this loss of BMD is not as severe as it is in the case of osteoporosis. Osteopenia is a term to define bone density that is not normal but also not as low as osteoporosis. By definition from the World Health Organization osteopenia is defined by bone densitometry as a T score -1 to -2.5.[1] [2] By deduction osteopenia is often called a severe precursor for the development of osteoporosis. This however is not always the case, a person can be diagnosed with osteopenia but will not always develop osteoporosis. With this in mind osteopenia should instead be characterised as a severe risk factor for developing osteoporosis and be treated as such.

Epidemiology

The current combined prevalence of osteopenia and osteoporosis is estimated at approximately 55% among people aged 50 and older and the total number of cases is expected to grow over the next decade.
During 2010 a prevalence for osteopenia was examined in seven country’s (the US, Japan, France, Germany, Italy, Spain, and the UK) and was estimated to 117.9 million cases.
The prediction in the same source states that prevalence by 2020 will have risen by 14% resulting in 134.8 million cases in the seven examined country’s.

Etiology

Throughout a patient’s lifetime BMD is constantly lowering. But the rate at wich this happens is about 0.7%/year, this means that even at old age the loss of BMD is not critical.
However when a patient has low BMD to begin with the process of BMD-loss can create a great risk of fractures.
The process of bone maintenance is called “remoddeling”, this process takes about 8 months and is quite slow. Osteoblast develop into new bone cells and thus compensate for the breakdown of old and worn cells.
At the same time osteoblasts secrete a hormone wich keeps osteoclast activity under control, thus preventing excessive bone breakdown.
Peak BMD is achieved around the age of 21, after this point it starts to lower.
This means it is extremely important to devlop a high BMD at young age, this can be achieved by having a healthy and active lifestyle. Sports like running are recommended because they put stress on the bones and increase the activity of osteoblasts.
In the case of women extra risk comes with aging. Post menopausal women have a significant change in their hormone balance, this influences the function of osteoblasts and thus the balance between bone remoddeling and re-uptake.

Characteristics/Clinical Presentation

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Differential Diagnosis

As will be explained below, the only way to differentiate between different degrees of BMD loss is by interpreting the t-score provided by a DEXA scan.

Diagnostic Procedures

Diagnostic procedure usually concists of a DEXA (dual emission x-ray absorptiometry) scan of the lumbar spine and hip.
during this process 2 x-rays with different energy levels are aimed at the patient.
Depending on how much of the energy of each beam is absorbed by the patient’s bones, the test results in a t-score:
international classifications determin that:

t-score between +1 and -1 indicates normal bone density.
t-score between -1 and -2.5 indicates low bone density or osteopenia. 
t-score of -2.5 or lower is proof of osteoporosis.

Outcome Measures

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Examination

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Medical Management

Medical treatment is generally not given to people with early stage osteopenia.
This type of treatment is reseverd for patients diagnosed with high risk of developping actual osteoporosis and people who actually have osteoporosis.
An example of medical treatment:
Evidence was found that treatment with Genistein in osteopenic post menopausal women increased BMD of the femur and lumbar spine, also it had significant increasing effects on quantative ultrasound parameters

Physical Therapy Management


the purpose of the therapy is the same in every case: trying to enhance BMD and slowing/preventing loss of BMD.

Pre menopausal:
In this group of patients the effects of exercise therapy are more significant and almost always result in an increase of BMD. Evidence was found that lower extremity exercise can result in an increase of BMD at  the hip and great trochanter but does not have increasing effects on the spine(8)(10).
However when combined with upper body exercises significant increase of BMD was measured in the lumbar spine(10).

Post menopausal:
Exercise therapy has proven to be a valuable therapy resource in the slowing down or preventing of BMD loss, there is however contradictory evidence when it comes to the increase of BMD effects.
Some studies mention an actual increase(13)(9) while others do not(7)(11).
However In this last case (11) the exercise therapy consisted of specific high impact exercises and there was report of an increase in Bone mineral content.

Key Research

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Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

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  1. WHO Scientific Group on the Prevention and Management of Osteoporosis (2000 : Geneva, Switzerland) (2003). "Prevention and management of osteoporosis : report of a WHO scientific group" (PDF). Retrieved 2007-05-31.
  2. Karaguzel G, Holick MF (2010): Diagnosis and treatment of osteopenia. Rev Endocr Metab Disord. 11(4):237-51. doi: 10.1007/s11154-010-9154-0.