Osteopenia

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Introduction

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. 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

Epidemiology

• 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.

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 mass, and hormonal influence.

Histopathology

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

Diagnosis

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.

Treatment/Management

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.

Physiotherapy management

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.