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Osteopenia: Early signs of bone loss

Osteopenia refers to early signs of bone loss that can develop into osteoporosis. With osteopenia, bone mineral density is lower than normal. However, it is not yet low enough to be considered osteoporosis.

Not everyone who has osteopenia will develop osteoporosis. There are lifestyle changes a person with osteopenia can take to ensure that their bones do not deteriorate further, including eating a healthy diet, doing regular weight bearing exercise, cutting down on caffeine and alcohol and quitting smoking.

In 2010, the actress Gwyneth Paltrow told fans she had osteopenia. She found out after a bone scan (DXA scan) after a fracture some years ago, and was also found to have very low Vitamin D levels.

With ageing, more bone cells are lost than are made. This can make the bones weaker and lead to osteopenia and osteoporosis. The bones become more vulnerable to fractures and other damage.

At what age does bone mass start to decline?

Bone mass, or the amount of bone you have, usually peaks around the age of 30. Then bone mass begins to decline. Your body starts to reabsorb bone faster than new bone can be made. This bone reabsorbtion is accelerated after the menopause.

How do I know if I'm at risk of osteopenia or osteoporosis?

Most people with osteopenia don't know it. In fact, the first sign may be a broken bone. A broken bone may mean that you already have osteoporosis.

What are some risk factors for osteopenia and osteoporosis?

Risk factors for developing osteopenia are the same as those for developing osteoporosis. They include:

  • Being female
  • Being thin and/or having a small frame
  • Getting too little calcium in the diet
  • Smoking
  • Leading an inactive lifestyle
  • A history of anorexia nervosa
  • A family history of osteoporosis
  • Heavy alcohol consumption
  • Early menopause

How can my GP test for osteopenia and osteoporosis?

The most accurate way to diagnose osteopenia and osteoporosis is through bone mineral density testing. This is usually done with a dual-energy X-ray absorptiometry (DEXA) scan.

DEXA scan results are reported as T-scores:

  • Normal bone: T-score above -1
  • Osteopenia:   T-score between -1 and -2.5
  • Osteoporosis: T-score below -2.5

Other tests can be done to help diagnose osteoporosis and osteopenia. Quantitative ultrasound is one such test. It measures the speed of sound in the bone to assess bone density and strength. DEXA scans are usually still needed to confirm results from ultrasound and other tests.

Who should get a bone density test?

Experts advise that you should receive a bone density scan if you have certain risk factors. These include:

  • Age. The older you are the more at risk you are of having osteoporosis
  • Weight. If you are abnormally thin you are at increased risk
  • Previous fracture. This puts you at a much higher risk of having osteoporosis especially if the trauma was mild
  • Family history of fracture
  • Current smoker
  • Been on long term steroids. Prescribed a large dose of steroids for more than three months
  • Chronic medical problems or conditions such as rheumatoid arthritis, malabsorption, malnutrition, premature menopause, hyperthyroidism, hypogonadism, type 1 diabetes, or chronic liver disease
  • Alcoholism, particularly if drinking more than three units of alcohol per day.

Your GP will take a detailed medical history and normally using an assessment tool to calculate whether a DEXA scan is appropriate for you.

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