Advises: Mr. George Kountis, PhD, MSc Orthopedic Surgeon, Doctor of the University of Athens, Curator of the 2nd Hospital of KAT

Osteopenia: the beginning or the end of osteoporosis?

1. What is osteopenia and what is the difference between it and osteoporosis?

Bone is a living and very active tissue, which is constantly being created and destroyed at the same time. When for some reason, this destruction is more than the creation, then the bone “thins”, meaning that its density decreases. This condition is scientifically called osteopenia when it is in a relatively mild form, and if the reasons that cause it do not stop, then it gradually progresses to osteoporosis which is the worst form. Osteopenia means low bone density. This is different from osteoporosis which is a common condition in which the bones are brittle, weak and at increased risk of fracture. Thus, osteopenia is not a disease, but an indicator of an increased risk of developing osteoporosis.

2. At what age can osteopenia show up?

Osteopenia is usually discovered after the age of 50, most often by chance, but it actually starts a few decades earlier and progressively worsens towards osteoporosis. More than 80% of people with osteopenia are women, and it is estimated that at least one in two women and one in eight men over the age of 50 will develop osteoporosis and eventually will be led to fracture.

3. Is osteopenia related to poor or malnutrition during childhood and adolescence?

The basic food of human in his infancy and infancy, as in all mammals, is milk. Milk, as well as other dairy products, play a fundamental role in the development of the skeleton since its basic composition is calcium, an element necessary for bone quality. In a person who for some reason the intake of calcium in his diet during childhood and adolescence is not satisfactory, lays the foundation for a “poor” bone quality (osteopenia), which over time may be developed into osteoporosis. Calcium is stored in the bones until the age of 30-35 years. Then begins the normal decrease in bone density, which we can only mitigate, but not stop.

4. How do I know if I have osteopenia?

With the same method that we measure osteoporosis. The measurement of bone density. Measuring bone density is a simple, painless test, like a “small” CT scan, but with far less radiation than even a plain X-ray.

The values we receive from this bone density measuring machine are in absolute numbers, and are indicative of the condition we may have: Values from 1 to 2.5 SD (units) below the average value of the top bone density of young adults is defined as osteopenia or low bone density, while above 2.5 units (SD) below the midline is osteoporosis.

5. What conditions cause osteopenia?

The conditions that can cause osteopenia as well as the predisposing factors for its development are: age, low body weight, anorexia nervosa, sedentary lifestyle, menopause and the following years, low testosterone (in men), consumption of alcohol, salt, smoking, low calcium diet, increased caffeine intake, lack of vitamin D, etc.

We must not forget that family history is also very important, as first-degree relatives are more likely to develop osteopenia, which if left untreated will develop into osteoporosis (although this is not absolute).

6. From what age should I take the necessary exams?

In case there are any of the above mentioned risk situations or there is a clear hereditary history, it would be good, especially women, after 40 or during menopause, to take a Bone Density measurement (e.g. DEXA) to have it as a reference point, even if the measurement is perfectly normal, it must be repeated after a year to determine if it remains at the same normal level, or has a declining course – meaning that it loses bone.

7. Is osteopenia treated, and if so how?;

Osteopenia, as it is mentioned above, is not a disease, but an indicator of an increased risk for osteoporosis. For its development, genetic factors play the most important role (around 60-80%). Therefore we can only change where the rest are. Since we cannot change the genetic material we must pay special attention to the factors that we can change, i.e. the other 20 to 40%. Prevention is the best approach to this situation. In detail:

A) Eat foods rich in calcium such as dairy, green vegetables, sardines, rosé salmon, small fish eaten with bone, nuts, sesame, etc., as well as foods rich in vitamin D which is absolutely necessary for the absorption of calcium, such as: Cod, Shrimp, Milk, etc. Ask your doctor if it is good for you to take calcium supplements. Some foods, such as chocolate, cocoa, but also spinach and turnips, contain oxalic acids, which interfere with the body’s absorption of calcium. Of course, this happens when the above foods are over-consumed.

B) Take advantage of the sun: Fifteen to twenty minutes of sun exposure help the body synthesize vitamin D, which is necessary for better absorption of calcium. Given that our country has sunshine, it is estimated that we do not need vitamin D supplements.

C) Normal body weight, a balanced healthy diet and daily physical exercise, are the ideal elements to prevent the development of osteopenia in osteoporosis. Exercises that force the body to carry weight, such as walking, skipping rope, dumbbells, etc., actually help to strengthen the muscular system and consequently maintain the health of bones and joints.

D) Do not smoke! Among other things, smoking is considered a risk factor for the occurrence of osteopenia and osteoporosis, especially when it coexists with other risk factors for the occurrence of the disease, such as the excessive consumption of alcohol and coffee as well as the extremely low body weight.

8. Is osteopenia prevented by exercise in childhood?

Proper and frequent dynamic exercise can maintain and increase muscle mass in all age groups. Sport is much more important in children and adolescents, where the stimulus of bone formation is more intense than in older ages. Exercise in childhood and adolescence increases bone density in middle age regardless of subsequent exercise.

Dynamic exercise three to five times a week is more than enough to increase, maintain or moderate the rate of bone loss. Exercise with weights is ideal and provides the maximum stimulus to increase bone density. Even athletes in endurance sports need to do weight training to maintain their muscle mass, as long as it is done properly. This is much more important for women athletes.

9. Anorexia nervosa & osteopenia

Eating disorders are the scourge of our century as they affect 1-5% of the population and their frequency occurs mainly in the female population rather than the male, with an incidence ratio of 10:1.

Anorexia nervosa, due to the almost complete abstinence from food in general, leads to a gradual weakening of the muscular system, which results in osteopenia and severe vitamin deficiency, and can even lead to death.

10. I have osteopenia. How fast can osteoporosis develop?

Let’s not forget that osteopenia is not a disease but a precursor – a warning – to osteoporosis. How fast it will develop is multifactorial, and depends on a person’s predisposition to develop osteoporosis (genetic factors), eating habits and peculiarities, how much the person walks or exercises, and much more.        

11. I have osteopenia. Can it return to normal levels?

Osteopenia, in the early stages and with the appropriate adaptation of the person to a diet with more calcium and vitamin D, with intensive exercise and reduction of abuse (alcohol-smoking) can return to normal levels for the age even without the administration of medicinal products.