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Osteoporosis vs Osteopenia : What is the Difference?

Osteoporosis vs Osteopenia : What is the Difference?
Christine Kijek

Bone density refers to the mineral level within the bones. Osteopenia is the term used when bone density is lower than it should be. As density in the bone decreases, the risk for injury to the bone with normal activity increases. Many factors play a part in bone health. Bone breaks down faster than the body can build new bone tissue as we age. Bone density can be increased by eating a healthy diet and exercising.  

Osteoporosis is a condition where the bone is weakened to a point when an injury occurs easily with normal activity. Not all people with osteopenia progress to osteoporosis. Once diagnosed with osteopenia, your healthcare provider should recommend a diet higher in calcium and vitamin D, along with exercise. Your bone density should be monitored regularly.  

Bone Density  

Peak bone density occurs in the mid-thirties. Bone tissue builds more than the amount lost up to age 30. By age 35, bone loss or breakdown occurs faster than the rate of building new bone tissue. Women lose bone density much quicker with age and menopause than men do. Hormone production (estrogen) in women decreases after menopause, around the age of 50. While testosterone levels decrease in men, it is a slower process but can increase the risk of osteopenia around the age of 65.  

Osteopenia Risk Factors

Lifestyle can increase your risk for osteopenia. These include:

  • Unhealthy diet/poor nutrition
  • Lack of calcium or vitamin D  
  • Lack of exercise  
  • Strength training  
  • Smoking  
  • Excessive alcohol intake  
  • Excessive caffeine intake  

Osteopenia causing Health Conditions

Certain health conditions increase your risk as well. These include:

  • Hyperthyroid or taking too much thyroid medication  
  • GI conditions- untreated celiac disease, Crohn’s disease  
  • Auto-immune conditions such as lupus or rheumatoid arthritis  
  • Eating disorders such as anorexia or bulimia  
  • Chemotherapy or radiation treatments  
  • Medications- steroids (prednisone), antiseizure meds, a medication that treats nerve pain  
  • Taking medication for hypertension (high blood pressure)
  • Taking medications for heartburn (PPI or H2 blocker)  

Osteopenia Diagnosis  

Osteopenia does not cause symptoms until it progresses to osteoporosis. There is no bone pain or weakness noted. It is often discovered by bone mineral density testing. Bone density is measured by an X-ray called DEXA (dual-energy X-ray absorptiometry) or is otherwise called a bone mineral density (BMD) test. This test provides a T-score.  

  •  +1 to –1 indicates the normal bone density  
  • -1 to –2.5 indicates osteopenia  
  • -2.5 or lower indicates osteoporosis  

It is recommended for a DEXA test be done for:

  • Women over the age of 65  
  • Postmenopausal women under the age of 65 with other risk factors  
  • Men over the age of 65 with risk factors  
  • History of a bone break with normal activity  

Osteopenia Bone Loss - Prevention and treatment  

The best way to prevent osteoporosis is to treat osteopenia by building bone density. The amount of calcium intake a day should be 1200 mg. Foods high in calcium include:  

  • Dairy products – Milk, cheese, yogurt  
  • Spinach, broccoli  
  • Dried beans  
  • Salmon  

*Of note, if taking a calcium supplement, the body can absorb only 600 mg at a time. It is recommended to take 600 mg twice a day.  

Calcium is best absorbed when taken with vitamin D. The recommended daily amount is 800 units (IU, international units) which can be found in:  

  • Eggs  
  • Salmon or sardines  
  • Fortified cereals, bread, and orange juice  

*Of note, spending time in the sun helps vitamin D absorption.  

Exercise can strengthen and build bone density. Weight-bearing exercise is best. Weight-bearing exercises are considered to be those where your feet are on the ground. These include:  

  • Walking  
  • Running or jogging  
  • Jumping rope  
  • Stair/step master  
  • Strength training exercises 
  • Resistance bands  

Medications for Osteoporosis  

Medication to help build bone density with osteopenia is not always used unless osteopenia is close to becoming osteoporosis. Calcium and vitamin D supplements may be recommended if diagnosed with osteopenia. Prescription medications that help increase bone density are-

  • Alendronate (Binosto or Fosamax)  
  • Ibandronate (Boniva)  
  • Raloxifene (Evista)  
  • Risedronate (Actonel, Atelvia)  
  • Zoledronic acid (Reclast, Zometa)  

Osteoporosis Precautions

Along with maintaining a healthy lifestyle, it is very important to prevent falls. Falls are the number 1 cause of injury to the bones for those with osteoporosis. You should take steps to reduce your risk of experiencing a fall.  

  • Be sure you have adequate lighting in your home  
  • Install railings in showers and on stairways  
  • Avoid tripping hazards such as area rugs, small furniture  
  • Don’t leave objects out of place  
  • Clean up any spills  
  • Treat slippery surfaces including those with ice or snow  
  • Use non-skid rugs  
  • Wear no-skid slippers
  • Correct visual impairments  
  • Decrease sedative type medications  

If you happen to be diagnosed with osteopenia, talk with your doctor about regular bone density testing to monitor for osteopenia. That means you should have a DEXA scan every 2-3 years. Adjust your lifestyle to maintain a healthy diet and keep active. These will slow the progression of bone loss. 


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HPFY Christine Kijek

Christine Kijek

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Christine Kijek is a registered nurse with a Bachelor of Science degree in Nursing. She has completed courses for wound and ostomy specialty and has 20 years of experience. She has been ...

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