Osteopenia is a bone condition defined as low bone mass that can progress to a more severe metabolic bone disorder know as osteoporosis. Osteoporosis is characterized by low bone density, poor bone tissue quality and changes in bone microarchitecture that increases risk of fracture. It is a silent disease that often goes undiagnosed until there is a fracture and places a large burden on patients and the healthcare system as a whole. It has been found that 1in 2 post menopausal women and 1 in 4 men over age 50 will experience a fracture due to osteoporosis.
There are two types of osteoporosis, primary and secondary. Primary osteoporosis is the most common form and includes post-menopausal osteoporosis and senile osteoporosis (osteoporosis in elderly men and women due to prolonged imbalance between bone resorption and bone formation). There are many causes for secondary osteoporosis including endocrine disorders, nutritional deficiencies, drugs and prescription medications, collagen disorders and various other systemic disorders.
Causes and Risk Factors
Risk factors for osteoporosis:
Lifestyle factors: alcohol abuse, smoking, vitamin D deficiency, calcium deficiency, low BMI, prolonged immobilization, inadequate physical activity, high salt intake, excess vitamin A
Age: risk increases as you age
Family history of osteoporosis and fractures
Ethnicity: caucasian and asian women are at highest risk
Low estrogen in post menopausal women and low testosterone in men
Secondary causes of osteoporosis can be reviewed below:
Table 1: Secondary Causes of Osteoporosis. Courtesy of Bone Health & Osteoporosis Foundation
Osteoporosis can be a clinical diagnosis in the presence of a fragility fracture of the hip, spine, humerus, distal radius, rib or pelvis in postmenopausal women.
Bone Mineral Density (BMD) can be assessed with a Dual energy x-ray absorptiometry (DXA) scan and is indicated in women over 65 years old and in men over 75 years old, any adult who has a fracture after age 50, and for younger patients who have increased risk factors for osteoporosis.
Your provider may also use the Fracture Risk Assessment Tool to determine your 10 year risk of fracture to drive clinical decision making.
Management and Prevention
Treatment of osteoporosis focuses on preventing further bone loss and restoring bone.
Lifestyle modifications including dietary supplementation, weight bearing exercise and smoking/alcohol cessation are crucial in preventing further bone loss and promoting bone restoration. Click here for more information regarding lifestyle recommendations for osteoporosis.
Pharmacologic therapy may be necessary to decrease fracture risk and promote increased bone density. There are several different types of medications that may be recommended for treatment of osteoporosis including:
Selective estrogen receptor modulators (SERMs)
estrogen replacement therapy
Speak with your healthcare provider today for more information on lifestyle and medical treatment options for osteopenia and osteoporosis.
Click here to learn more about osteoporosis.