Osteopenia: Difference between revisions

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== Definition/Description  ==
== Introduction ==


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.<ref>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.</ref> <ref>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.</ref> 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.
Osteopenia is a condition characterised by the loss of [[Bone Density|bone mineral density (BMD]]), this loss of BMD is not as severe as it is in the case of [[osteoporosis]]. By definition from the World Health Organization osteopenia is defined by bone densitometry as a T score -1 to -2.5.<ref>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.</ref> <ref>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.</ref>


# Osteopenia will not cause any symptoms itself.
# Osteopenia is a severe risk factor for developing osteoporosis.
Watch this 90 second video to get a picture of osteopenia
{{#ev:youtube|dtdEluROrbI|300}}<ref>FW BSI. Fort Worth Brain and Spine Institute - What is Osteopenia?. Available from: http://www.youtube.com/watch?v=dtdEluROrbI [last accessed 30/09/2022]</ref>
==  Epidemiology  ==
==  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. <br>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.<br>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.
* Worldwide, Asia has reported the lowest average t-scores by region.
* Overall, females have a four-fold higher overall prevalence of osteopenia compared to males. 
* Australia reported an incidence rate of osteopenia in 42% of men and 51% of women.  
* India reported a 52% overall incidence in its population in 2005.
* In the United States, 54% of post[[Menopause|menopausal]] women are osteopenic.<ref name=":0">Varacallo M, Seaman TJ, Jandu JS, Pizzutillo P. Osteopenia. StatPearls.Available:https://www.ncbi.nlm.nih.gov/books/NBK499878/ (accessed 4.12.2022)</ref>


==  Etiology  ==
==  Etiology  ==
Bone mineral accretion from birth to adulthood follows a predictable course for the individual’s age and sex. Peak BMD is achieved typically by age 17 for females and 21 for males, after this point it starts to lower. Failure to achieve peak bone mass as a young adult results in early-onset conditions of decreased bone mass. It is estimated that heritable factors control up to 80% of our ability to gain and maintain optimal bone mineralization levels, modifiable factors credited to the rate of natural bone mass reduction into adulthood include weight-bearing exercises, adequate calcium and vitamin D daily intake, [[Body Composition|body mass]], and [[Hormones|hormonal]] influence.<ref name=":0" />


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.<br>However when a patient has low BMD to begin with the process of BMD-loss can create a great risk of fractures.<br>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.<br>At the same time osteoblasts secrete a hormone wich keeps osteoclast activity under control, thus preventing excessive bone breakdown.<br>Peak BMD is achieved around the age of 21, after this point it starts to lower.<br>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.<br>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.
== Histopathology ==
Histologic specimens demonstrate noticeably thinned trabeculae, decreased osteon size, and enlarged haversian and marrow spaces.<ref name=":0" />
[[File:Cancellous bone - Trabecular bone - Normal trabecular bone Trabecular bone etc -- Smart-Servier (cropped).jpeg|center|frameless|585x585px|Cancellous bone - Trabecular bone - Normal trabecular bone Trabecular bone]]


== Characteristics/Clinical presentation  ==
== Diagnosis ==
[[File:DEXA scanner in use ALSPAC.jpeg|thumb|239x239px|DEXA scanner]]
Diagnostic procedure usually consists of a [[Dual Energy X-ray Absorptiometry (DEXA Scan)|DEXA]] (dual emission x-ray absorptiometry) scan of the lumbar spine and hip. See link<br>The WHO defines t-scores


== Differential diagnosis  ==
# t-score between +1 and -1 indicates normal bone density.
# t-score between -1 and -2.5 indicates low bone density or osteopenia.&nbsp;
# t-score of -2.5 or lower is proof of osteoporosis<ref name=":0" />.


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.
== Treatment/Management ==
[[File:Dairy-Products.jpg|thumb|Calcium rich foods]]
The main treatment recourse for osteopenic patients involve early education on how to achieve and maintain healthy bone mass levels and extensive education on the relevant social, environmental, and lifestyle risk factors that effect bone health. Medical treatment is generally not given to people with early-stage osteopenia.


== Diagnostic procedures  ==
All clinicians should educate patients about the morbidity of osteopenia. In particular encourage the patient to


Diagnostic procedure usually concists of a DEXA (dual emission x-ray absorptiometry) scan of the lumbar spine and hip. <br>during this process 2 x-rays with different energy levels are aimed at the patient.<br>Depending on how much of the energy of each beam is absorbed by the patient’s bones, the test results in a t-score:<br>international classifications determin that:<br><br>t-score between +1 and -1 indicates normal bone density. <br>t-score between -1 and -2.5 indicates low bone density or osteopenia.&nbsp; <br>t-score of -2.5 or lower is proof of osteoporosis.
* Eat a healthy diet rich in calcium
 
* Exercise, cease smoking, and keep alcohol to a minimum.<ref name=":0" />  
== Outcome Measures ==
 
== Examination  ==
 
add text here related to physical examination and assessment<br>
 
== Medical management  ==
 
Medical treatment is generally not given to people with early-stage osteopenia.<br>This type of treatment is reserved for patients diagnosed with high risk of developing actual osteoporosis and people who actually have osteoporosis.<br>An example of medical treatment:<br>Evidence was found that treatment with Genistein in osteopenic postmenopausal women increased BMD of the femur and lumbar spine, also it had significant increasing effects on quantative ultrasound parameters


== Physiotherapy management  ==
== Physiotherapy management  ==


The purpose of the therapy is the same in every case: trying to enhance BMD and slowing/preventing loss of BMD.<br><br><u>Premenopausal</u>: <br>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&nbsp; the hip and great trochanter but does not have increasing effects on the spine(8)(10).<br>However when combined with upper body exercises significant increase of BMD was measured in the lumbar spine(10).<br><br><u>Postmenopausal:<br></u>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.<br>Some studies mention an actual increase(13)(9) while others do not(7)(11). <br>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.
The purpose of the therapy is the same in every case: trying to enhance BMD and slowing/preventing loss of BMD. For physiotherapy management see relevant section of [[Osteoporosis]]<ref>Ramos LA, Rodrigues FT, Shirahige L, Barros MD, de Carvalho AG, Guerino MR, de Lima Ferreira AP, Guerra RO, de Araújo MD. [https://www.ncbi.nlm.nih.gov/pubmed/31275877 A single whole body vibration session influences quadriceps muscle strength, functional mobility and balance of elderly with osteopenia and/or osteoporosis? Pragmatic clinical trial.] Journal of Diabetes & Metabolic Disorders. 2019 Jun 1;18(1):73-80.</ref>.
 
A randomised control trial reports improvement in quadriceps muscle strength and balance with a single session of Whole Body Vibration (WBV) in elderly patients affected with osteopenia and osteoporosis<ref>Ramos LA, Rodrigues FT, Shirahige L, Barros MD, de Carvalho AG, Guerino MR, de Lima Ferreira AP, Guerra RO, de Araújo MD. [https://www.ncbi.nlm.nih.gov/pubmed/31275877 A single whole body vibration session influences quadriceps muscle strength, functional mobility and balance of elderly with osteopenia and/or osteoporosis? Pragmatic clinical trial.] Journal of Diabetes & Metabolic Disorders. 2019 Jun 1;18(1):73-80.</ref>.  
 
== Resources  ==
 
== Clinical Bottom Line  ==


<div class="researchbox"> </div>
== References  ==
== References  ==


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[[Category:Older People/Geriatrics]]
[[Category:Older People/Geriatrics]]
[[Category:Older People/Geriatrics - Conditions]]
[[Category:Older People/Geriatrics - Conditions]]
[[Category:One Page Project]]

Latest revision as of 14:58, 16 December 2022

Introduction[edit | edit source]

Osteopenia is a condition characterised by the loss of bone mineral density (BMD), this loss of BMD is not as severe as it is in the case of osteoporosis. By definition from the World Health Organization osteopenia is defined by bone densitometry as a T score -1 to -2.5.[1] [2]

  1. Osteopenia will not cause any symptoms itself.
  2. Osteopenia is a severe risk factor for developing osteoporosis.

Watch this 90 second video to get a picture of osteopenia

[3]

Epidemiology[edit | edit source]

  • Worldwide, Asia has reported the lowest average t-scores by region.
  • Overall, females have a four-fold higher overall prevalence of osteopenia compared to males.
  • Australia reported an incidence rate of osteopenia in 42% of men and 51% of women.
  • India reported a 52% overall incidence in its population in 2005.
  • In the United States, 54% of postmenopausal women are osteopenic.[4]

Etiology[edit | edit source]

Bone mineral accretion from birth to adulthood follows a predictable course for the individual’s age and sex. Peak BMD is achieved typically by age 17 for females and 21 for males, after this point it starts to lower. Failure to achieve peak bone mass as a young adult results in early-onset conditions of decreased bone mass. It is estimated that heritable factors control up to 80% of our ability to gain and maintain optimal bone mineralization levels, modifiable factors credited to the rate of natural bone mass reduction into adulthood include weight-bearing exercises, adequate calcium and vitamin D daily intake, body mass, and hormonal influence.[4]

Histopathology[edit | edit source]

Histologic specimens demonstrate noticeably thinned trabeculae, decreased osteon size, and enlarged haversian and marrow spaces.[4]

Cancellous bone - Trabecular bone - Normal trabecular bone Trabecular bone

Diagnosis[edit | edit source]

DEXA scanner

Diagnostic procedure usually consists of a DEXA (dual emission x-ray absorptiometry) scan of the lumbar spine and hip. See link
The WHO defines t-scores

  1. t-score between +1 and -1 indicates normal bone density.
  2. t-score between -1 and -2.5 indicates low bone density or osteopenia. 
  3. t-score of -2.5 or lower is proof of osteoporosis[4].

Treatment/Management[edit | edit source]

Calcium rich foods

The main treatment recourse for osteopenic patients involve early education on how to achieve and maintain healthy bone mass levels and extensive education on the relevant social, environmental, and lifestyle risk factors that effect bone health. Medical treatment is generally not given to people with early-stage osteopenia.

All clinicians should educate patients about the morbidity of osteopenia. In particular encourage the patient to

  • Eat a healthy diet rich in calcium
  • Exercise, cease smoking, and keep alcohol to a minimum.[4]

Physiotherapy management[edit | edit source]

The purpose of the therapy is the same in every case: trying to enhance BMD and slowing/preventing loss of BMD. For physiotherapy management see relevant section of Osteoporosis[5].

References[edit | edit source]

  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.
  3. FW BSI. Fort Worth Brain and Spine Institute - What is Osteopenia?. Available from: http://www.youtube.com/watch?v=dtdEluROrbI [last accessed 30/09/2022]
  4. 4.0 4.1 4.2 4.3 4.4 Varacallo M, Seaman TJ, Jandu JS, Pizzutillo P. Osteopenia. StatPearls.Available:https://www.ncbi.nlm.nih.gov/books/NBK499878/ (accessed 4.12.2022)
  5. Ramos LA, Rodrigues FT, Shirahige L, Barros MD, de Carvalho AG, Guerino MR, de Lima Ferreira AP, Guerra RO, de Araújo MD. A single whole body vibration session influences quadriceps muscle strength, functional mobility and balance of elderly with osteopenia and/or osteoporosis? Pragmatic clinical trial. Journal of Diabetes & Metabolic Disorders. 2019 Jun 1;18(1):73-80.