bone health

Osteopenia

Generality

Osteopenia is a systemic condition of the skeleton, characterized by a reduction in bone mineral density values ​​(BDM) less severe than that which can be observed in the presence of osteoporosis.

Various factors can cause the reduction of BDM, including: advanced age, a particular family predisposition to disorders such as osteopenia or osteoporosis, cigarette smoking, alcohol abuse, a drop in estrogen ( in women) or testosterone (in humans), anorexia nervosa, poor exercise, the intake of certain drugs (chemotherapy or corticosteroids), an incomplete diet, food-related disorders, etc.

Osteopenia is not a cause of symptoms, but rather a reason for a certain predisposition to fractures.

The treatment of osteopenia involves the adoption of a lifestyle and diet appropriate to the present condition and, sometimes, the use of certain medicines.

What is osteopenia?

Osteopenia is the medical term that indicates the presence of a bone mineral density (BDM) lower than normal levels, but not low enough to talk about osteoporosis.

In other words, osteopenia is a condition of the bones, characterized by a reduction in bone mineral density values ​​that is less severe than that observed in the presence of osteoporosis.

WHAT IS BONE MINERAL DENSITY?

Bone mineral density (BMD, from the English Bone Mass Density ) is a measure of the quantity of minerals ( bone mineral mass ) contained in a cubic centimeter of bone (volume).

Bone mineral density is an indicator of fracture resistance, possessed by bones: BMD values ​​below normal are indicative of a certain bone fragility and a greater susceptibility, on the part of the skeleton, to suffer fractures.

The bone mineral mass is the parameter that indicates the quantity of minerals present in an individual's skeleton.

WHAT IS OSTEOPOROSIS? WHAT RELATIONSHIPS HAVE WITH OSTEOPENIA

Osteoporosis is a systemic disease of the skeleton, which causes a strong weakening of the bones. This weakening results from the reduction of bone mass, which, in turn, is a consequence of the deterioration of the microarchitecture of the bone tissue.

People with osteoporosis are more prone to fractures because they have more fragile bones than normal.

Osteoporosis and osteopenia are two very similar conditions, especially as regards the causes and pathophysiological mechanisms.

What distinguishes them - as can be guessed from the definition of osteopenia - is the degree of reduction in bone mineral density, much more serious in the former than in the latter.

All this affects the resistance of bones to fractures: in the case of osteoporosis, bone fragility is even lower than in the case of osteopenia.

OSTEOPENIA IS NOT ...

Perhaps due to the similarity between the names, many people tend to confuse osteopenia with three decidedly different bone diseases, which are: osteomalacia, osteomyelitis and osteoarthritis.

  • Osteomalacia : is a skeletal disease characterized by a process of defective bone mineralization (NB: in osteopenia and in osteoporosis the mineralization process takes place correctly). The typical consequence of osteomalacia is greater bone fragility.
  • Osteomyelitis : is the medical term that indicates the presence of an infection at the bone level.
  • Osteoarthritis : is one of the most common forms of arthritis. Arthritis is inflammation of the joints.

ORIGIN OF THE NAME OSTEOPENIA

The term osteopenia is the fruit of the union of two words of Greek origin, ostéon ( ὀστέον ) and penía ( πενία ).

  • Ostéon means "bone"
  • Penía means "poverty" or "lack".

Therefore, the literal meaning of osteopenia is "bone deficiency" or "bone poverty".

Causes

To learn more: Causes of Osteopenia

Due to a decrease in bone mineral mass, osteopenia recognizes numerous causes and various risk factors; causes and risk factors often act in concert, almost never individually.

Among the possible conditions at the origin of osteopenia and among its possible supporting factors, include:

  • Advanced age . The bones of the human skeleton are subject to continuous remodeling (or turnover). This remodeling consists in the destruction of a part of the constituent tissues (bone resorption) and in their substitution with newly created tissues (bone deposition).

    Up to about 30 years, the bone remodeling process sees deposition on resorption prevail.

    Starting at age 30, deposition and bone resorption are equivalent, establishing a sort of balance.

    In old age, resorption begins to prevail over deposition and this can lead to the onset of conditions, such as osteopenia or osteoporosis;

  • A particular family predisposition to the reduction of bone mineral density . This predisposition may be a factor favoring both osteopenia and osteoporosis (family history of osteopenia and / or osteoporosis);
  • The reduction of estrogen levels in women and the reduction of testosterone levels in humans. Estrogens and testosterone are two sex hormones of fundamental importance also for the good health of the bones and of the skeleton in general.

    The reduction in estrogen levels, observed in female subjects, is a typical consequence of menopause and represents one of the main factors favoring the appearance of osteopenia and osteoporosis;

  • Alcohol abuse ;
  • Cigarette smoke ;
  • Limited physical activity and immobility, due for example to a highly debilitating disease;
  • Exposure to ionizing radiation, for example during long radiotherapy treatments;
  • Intake of certain drugs, including chemotherapy drugs (chemotherapy), corticosteroids (prednisone) and antiepileptics . In these situations, osteopenia is an adverse effect of these medicines;
  • Poor dietary calcium intake and, in general, all eating disorders that affect the metabolism of vitamin D and / or minerals essential for good bone health (calcium and phosphorus). An eating disorder that typically causes osteopenia is celiac disease.
  • Anorexia nervosa ;
  • The extreme thinness ;

Symptoms and Complications

Osteopenia itself does not cause symptoms or signs of any kind.

Its presence, however, is a predisposing factor for bone fractures .

A bone fracture from osteopenia, as well as that from osteoporosis, is a very painful condition, which in some anatomical sites (for example, the hip) is difficult to heal spontaneously and, for this reason, requires reparative surgical intervention.

EXCEPTIONS

Curiously, some bone fractures due to osteopenia, which affect the vertebrae of the spine (vertebral or spinal fractures), are completely painless.

In these situations, the identification of the problem occurs in a completely random manner.

DOES OSTEOPENIA ALWAYS PREVENT OSTEOPOROSIS?

In various circumstances, the presence of osteopenia represents the prelude to a condition of osteoporosis.

However, it should be pointed out that there are also cases of osteopenia that remain such, that is they do not evolve into osteoporosis.

COMPLICATIONS OF BONE FRACTURES

In old age, bone fractures due to osteopenia - particularly those of the lower limbs - can severely affect life expectancy, causing the affected person to die prematurely.

In these situations, the possible causes of death include: venous thrombosis linked to immobility, stasis pneumonia, etc.

Diagnosis

For a correct diagnosis of osteopenia, the most suitable test is the so-called bone densitometry .

Bone densitometry is a diagnostic technique that allows the assessment of bone mineral density, ie the parameter that in case of osteopenia and osteoporosis is lower than normal values.

Other diagnostic tests, which doctors could resort to in case of suspected osteopenia, are: quantitative computed tomography, peripheral quantitative computed tomography and quantitative bone ultrasonography .

SOME MORE DETAILS ABOUT BONE DENSITOMETRY

The instrument for bone densitometry describes the bone mineral density of an individual through two parameters, referred to by the medical " T score " and " Z score ".

The " T score " is the measure of how much the bone mineral density value of the examined subject differs from the reference value, represented by the healthy population of 25-30 years and of the same sex.

The " Z score ", instead, is the measure of how much the bone mineral density value of the examined subject differs from the reference value, represented by the healthy population of the same age and sex.

To diagnose the presence of osteopenia, the parameter of interest is the " T score ": if an individual has a " T score " between -1 and -2.5, then he suffers from osteopenia.

In the table below, the reader can see the values ​​that the " T score " assumes, based on bone health.

T score valueBone health
≥ -1Normal
<-1 and ≥ -2.5Osteopenia
<-2.5Osteoporosis
<-2.5 with fractureSevere osteoporosis

Treatment

When they talk about treating osteopenia, doctors believe it is essential to adopt a lifestyle and a diet plan that reduces the process of bone resorption.

In addition to this, they could also prescribe a pharmacological type of therapy. The medicines prescribed in case of osteopenia are, for the most part, the same as those prescribed in case of osteoporosis.

Deepening: who is an expert in the diagnosis and therapy of osteopenia?

The medical specialists in the diagnosis and treatment of osteopenia are: rheumatologists (doctors specialized in rheumatology), endocrinologists (doctors specialized in endocrinology) and gynecologists (doctors specialized in gynecology).

WHAT IS THE MOST INDICATED LIFE STYLE?

To best cope with osteopenia and the risk of fractures resulting from it, doctors recommend a lifestyle that includes:

  • Physical load exercises . They are the physical activities in which body weight weighs on the bones. Their usefulness derives from the fact that the weight of the body, combined with the force of gravity, represents a positive stimulus to bone deposition; positive stimulus that results in an increase in bone density.

    The main physical exercise exercises include: walking, walking, dancing, hiking, climbing stairs, aerobics, light running (non-severe osteopenia) etc.

    For effective physical exercise to be carried out, a patient must perform them at least 2-3 times a week.

  • Physical resistance exercises . They consist of exercises with light or elastic weights and serve to strengthen the musculature and make it less rigid.

    A stronger and less rigid musculature reduces the risk of falls, and therefore also of fractures.

    To see the results of physical resistance exercises, it is good to do them 2-3 times a week.

  • Physical exercises of balance postural . They are physical activities that improve body alignment and balance. To appreciate its effects, it is good to carry them out continuously.
  • The renunciation of cigarette smoking, if clearly smoking.
  • The renouncement to the exaggerated intake of alcoholic substances, if clearly it is the avid drinkers.

WHAT IS THE MOST INDICATED DIET?

In the case of osteopenia, the most suitable diet is that which provides for an adequate intake (or intake ) of calcium and vitamin D.

The most calcium-rich foods are: milk, milk derivatives, green leafy vegetables, etc.

The foods with the highest vitamin D content, on the other hand, are: eggs, salmon, sardines, swordfish and fish oil, etc.

In some particular situations, doctors may consider it essential to support the dietary intake of calcium and vitamin D with special supplements.

To learn more: Example Diet for Osteoporosis

Please note: our body is able to take advantage of the vitamin D introduced with food only when exposed to sunlight.

In fact, sunlight triggers a cellular process that transforms the precursors of vitamin D from an unsuitable form to the human organism to a more usable form.

PHARMACOLOGICAL THERAPY

Osteopenia drugs include:

  • Bisphosphonates . They are medicines that can increase bone mineral density, limiting the process of bone decalcification.

    The most commonly administered bisphosphonates in case of osteopenia are: alendronate, risedronate, ibandronate and zoledronic acid.

  • Selective estrogen receptor modulators . They are drugs that stimulate receptors for estrogens, inducing effects similar to the latter (except on the uterus and on the breast).

    A selective estrogen receptor modulator commonly used in osteopenia is raloxifene. Raloxifene has the effect of increasing bone mineral density.

  • Teriparatide . It is a substance similar to the parathyroid hormone. Its function is to stimulate bone deposition.
  • Calcitonin . Has the effect of decreasing bone resorption.
  • The denosumab . It is a drug that, due to its induced effects, can replace bisphosphonates, when these are responsible for adverse effects in the patient.

Prognosis

Usually, with the adoption of the lifestyle and dietary plan described above, the loss of bone mineral mass tends to decrease or, at least, stabilize.

Therefore, in general, the prognosis in case of osteopenia is positive.

The lifestyle and the ad hoc diet may be ineffective, failing to give the desired results, if the patient suffers from difficult to treat eating disorders, has a predisposition to osteopenia / osteoporosis very accentuated, has severe hormonal imbalance or must take, due to other health problems, drugs among which adverse effects also appear osteopenia.

Prevention

The best way to prevent osteopenia is to live according to a healthy lifestyle, therefore to exercise regularly, not to smoke, not to abuse alcohol, to adopt a complete diet from the nutritional point of view, etc.

PREVENTIVE PHARMACOLOGICAL THERAPY: WHEN IT IS NEEDED?

When prescribing a long therapy based on corticosteroids or chemotherapy, doctors believe it is essential to make patients take a series of pharmacological substances for the prevention of osteopenia / osteoporosis.

Medicinal products used to prevent osteopenia and osteoporosis include bisphosphonates and raloxifene.