Bone mass and bone mineral density both decrease as people age. Osteopenia is a condition where people’s bone density is lower than is usual for their age. Osteoporosis is a more severe case of bone loss that weakens the bones and makes them more likely to fracture.
Bone mass and bone mineral density measure the amount of minerals such as calcium and phosphorus present in a set amount of bone. Osteopenia and osteoporosis are conditions that lead to a loss of bone mass and density, which can increase the risk of bones breaking.
In this article, we look at the differences between the two conditions, as well as symptoms, treatment, and prevention.
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth.
What are they?
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Osteopenia is a condition where people have a lower bone mass or bone mineral density than is usual for a person’s age. However, the bone mineral density is not low enough for healthcare professionals to diagnose osteoporosis.
Osteoporosis, on the other hand, is a bone disease where the bones become weak and are more likely to fracture. Osteoporosis happens when the body loses bone mass or density.
Typical bone structure resembles a honeycomb. When bone becomes less dense, the holes in the structure become larger, weakening the bone and potentially making it more prone to breaking.
How do they differ?
Osteopenia is less severe than osteoporosis.
Osteopenia is a loss of bone mass or bone mineral density. It is the stage before osteoporosis, and without treatment, it can progress to osteoporosis.
Osteoporosis happens when bone mineral density and bone mass decrease even further or when there are structural changes to bone tissue. Osteoporosis weakens the bones and increases the risk of fractures.
Symptoms
Osteopenia and osteoporosis do not usually cause any symptoms. Sometimes, a fracture is the first sign of either condition.
Height loss is a common symptom of osteopenia. Once a person reaches peak adult height, it is normal for them to lose height as they age. However, losing more height than normal may be a sign of an underlying issue with bone health.
People with osteopenia can be at risk of fractures. If a person over the age of 50 years falls from a low height, such as standing height, and breaks a bone, it may indicate a bone issue. They will need to undergo a bone density test to check for osteopenia or osteoporosis.
Osteoporosis can cause the bones to become very fragile, and people may experience fractures from very slight knocks or minor activity, such as:
- lifting
- coughing
- falling from standing height
Osteoporosis can cause vertebrae in the spine to collapse. Symptoms of vertebral collapse include:
- severe back pain
- height loss
- changes in posture, such as stooping or hunching
What are the causes and risk factors?
There are a number of causes of and risk factors for osteopenia and osteoporosis.
Osteopenia
According to a 2021 article, there are two main reasons people may develop osteopenia — not reaching their peak bone mass, which usually occurs in their 20s, and losing bone mass after reaching their peak bone mass.
A few factors can prevent people from reaching peak bone mass, including genetics. Heritable factors control up to 80% of a person’s ability to achieve and maintain bone mineralization levels.
Additionally, certain conditions may prevent the bones from absorbing enough calcium, thus preventing people from reaching peak bone mass. These conditions include:
- celiac disease
- inflammatory bowel disease
- having a body mass index of under 18.5
Other risk factors include:
- insufficient intake of vitamin D and calcium
- genetic factors, such as a predisposition to osteoporosis
- smoking
- excessive alcohol consumption
- low levels of physical activity
Individuals who have reached their peak bone mass may lose bone mass as they age or if they lose estrogen through menopause.
Osteoporosis
Without treatment, osteopenia can lead to osteoporosis.
Certain factors may increase the risk of osteoporosis, such as:
- Sex: Females typically have a lower peak bone mass and smaller bones than males. However, males over the age of 70 years are also at risk of developing the condition.
- Age: Bone loss occurs more quickly as a person ages.
- Body size: Thin-boned males and females are at higher risk of developing osteopenia, as there is physically less bone in their bodies.
- Family history: If a person’s parents have osteoporosis, the risk of developing it is higher.
- Ethnicity and race: White females, Asian females, and white males are at higher risk of osteoporosis than other populations.
- Hormonal changes: These include hormonal changes during menopause, absence of periods, and low testosterone levels in males.
- Diet: A diet low in calcium, vitamin D, and protein can increase an individual’s risk of developing osteoporosis.
- Long-term use of medications: These include anti-epileptic drugs, cancer medication, proton pump inhibitors, and selective serotonin reuptake inhibitors.
Among other risk factors are:
- low levels of physical activity and long periods of inactivity
- excessive alcohol consumption
- smoking
Certain medical conditions can increase the likelihood of developing osteoporosis, such as:
- endocrine diseases
- rheumatoid arthritis
- HIV and AIDS
- some types of cancer
- anorexia nervosa
- digestive disorders
Measuring bone mineral density
Doctors use bone mineral density tests to check for osteopenia or osteoporosis. They may use a dual-energy X-ray absorptiometry (DEXA) scan to check for bone mineral density throughout the body and in areas that may be more likely to fracture.
The DEXA scan is a quick, noninvasive test that shows calcium levels in the bone. During the test, a doctor will pass a scanner over the body to X-ray the bones.
They will then compare the DEXA scan results against the average bone mineral density levels in healthy bones of a young adult, known as a T-score, and against the average bone density of other people of the same age, sex, and race, called the Z-score.
Bone density below a certain level may indicate osteopenia or osteoporosis.
Treatment
The goal of treatment for osteopenia is to help prevent the condition from progressing to osteoporosis and to prevent fractures.
Treatment may include:
- following a diet rich in calcium
- getting enough vitamin D, which people may need to supplement
- doing regular weight-bearing exercise
- taking medications to prevent osteoporosis and increase bone density
If people have osteoporosis, the aim of treatment is to reduce bone loss and prevent fractures, and the treatment may include:
- eating a balanced diet, including foods rich in calcium and vitamin D
- avoiding smoking and limiting alcohol consumption, if applicable
- exercising to build muscle mass and improve strength and balance, which will help prevent falling
- taking certain medications to help reduce bone loss and risk of fractures
Prevention
It is not always possible to completely prevent osteopenia, as sometimes, it is due to genetic factors.
However, people can make dietary and lifestyle changes to help protect against osteopenia and to help prevent osteopenia from developing into osteoporosis. These changes include:
- performing regular exercise
- including enough calcium in the diet
- limiting alcohol consumption, if applicable
- stopping smoking, if applicable
Additionally, taking hormone therapy within 10 years of a person’s final menstruation can help prevent osteoporosis.
For those going through perimenopause, monitoring menstruation is important, as regular periods can indicate that the body is making enough estrogen, which is important for bone health.
If individuals have osteopenia, it is important they undergo regular tests to help monitor the condition and prevent it from progressing to osteoporosis.
Contacting a doctor
Osteopenia and osteoporosis do not always cause symptoms.
To detect any bone loss early, the National Osteoporosis Foundation recommends people contact a doctor for a bone density test if they:
- are a female over the age of 65
- are a male over the age of 70
- break a bone over the age of 50
- are going through menopause and have any risk factors
- are postmenopausal and under the age of 65 and have any risk factors
- are a male aged 50–69 years with any risk factors
- experience back pain with a possible break in the spine
- have a height loss of half an inch (in) or more in 1 year
- have a total height loss of 1.5 in from their original height
Summary
Osteopenia and osteoporosis are conditions that lead to a loss of bone mass and density, which can increase the risk of bones breaking.
Osteopenia is the initial stage of bone loss, which can progress to osteoporosis, a more severe condition, without treatment.
Regular weight-bearing exercise, a balanced diet rich in calcium, adequate vitamin D intake, and bone strengthening medications can help treat both osteopenia and osteoporosis.
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