Osteoporosis and Osteopenia

Osteoporosis and Osteopenia

Osteoporosis and osteopenia are conditions that develop when your bone density is lower than normal.

Osteoporosis is a bone disease that develops when your body loses too much bone, doesn’t make enough bone, or both. Low bone density makes bones weak and brittle and increases your risk of breaking a bone suddenly and unexpectedly. If you have osteoporosis, it’s possible to break a bone from falling down or even bending over or coughing.

Osteopenia is a condition that develops when you have low bone density and your bones are weaker than they should be. Osteopenia is not as severe as osteoporosis but often leads to osteoporosis if left untreated.

Both men and women can develop osteoporosis, but the risk is much higher if you’re a woman who’s gone through menopause. Estrogen levels fall during menopause, which can lead to bone loss. If you’ve been diagnosed with breast cancer, certain breast cancer treatments also can contribute to bone loss.

 

What causes osteoporosis and osteopenia?

Your bones are constantly renewing themselves. Although bones feel hard, they are living tissue. Each day, your body is making new bone and breaking down old bone. During your childhood and teenage years, your body makes new bone faster than it breaks down old bone and your bone density increases. After your early 20s, this process gradually slows down. As you get older, your body breaks down bone faster than it creates new bone.

You have a higher risk of developing osteopenia and osteoporosis if:

  • you are a woman

  • you are a transgender woman receiving certain hormone treatment but not taking estrogen, or who has had gender confirmation surgery with removal of the testicles but is not taking estrogen

  • you are a transgender man who has not started hormone therapy, who is taking certain types of hormone treatment, or who has had gender confirmation surgery with removal of the ovaries

  • you are older and have gone through menopause

  • you have a family history of osteoporosis

  • you have a small frame

  • you have overactive thyroid, parathyroid, or adrenal glands

  • you have a history of weight loss surgery or organ transplant

  • you have celiac disease or inflammatory bowel disease

  • you have rheumatoid arthritis

  • you don’t get enough calcium

  • you have an eating disorder

  • you don’t exercise

  • you have more than two alcoholic drinks per day

  • you smoke

Certain breast cancer treatments also can lead to osteopenia and osteoporosis.

Aromatase inhibitors. There are three aromatase inhibitors that treat breast cancer:

  • Arimidex (chemical name: anastrozole)

  • Aromasin (chemical name: exemestane)

  • Femara (chemical name: letrozole)

All three medicines work by stopping the body from making estrogen, and lower estrogen levels can lead to bone loss.

Chemotherapy. Some chemotherapy medicines that treat breast cancer can directly affect your bone density. Chemotherapy may cause early menopause, which puts you at higher risk for lower bone density. You also may receive steroids with certain chemotherapy medicines to reduce side effects, and taking steroids can lead to bone loss.

Ovarian shutdown. Ovarian shutdown — either by surgically removing the ovaries or stopping their function with medicine — causes a sudden drop in your body’s estrogen levels, which can lead to lower bone density.

 

Measuring bone density

Doctors measure bone mineral density with a DEXA (dual-energy X-ray absorptiometry) scan. Also called a DXA scan, a DEXA scan uses a very small amount of radiation to let doctors see the mineral content of certain bones — such as the hip, spine, and wrist. The scan is quick and painless.

Using a DEXA scan to measure bone mineral density at the hip and spine is considered the most reliable way to diagnose osteoporosis and predict the risk of breaking a bone.

Your DEXA scan results are made up of two scores:

  • T-score: Your T-score is the difference between your bone density and the average bone density of healthy 25- to 35-year-old adults of your same sex and ethnicity. A score of -1 and above is considered normal. A score of between -1 and -2.5 is classified as osteopenia, and a score of -2.5 and below is classified as osteoporosis. The lower the T score, the lower your bone mineral density.

  • Z-score: Your Z-score is your bone density versus what is considered normal bone density for someone your age, sex, ethnicity, height, and weight. Among older people, low bone mineral density is common, so Z-scores can be misleading.

The National Osteoporosis Foundation recommends you have a DEXA scan if:

  • you’re a woman age 65 or older

  • you’re a man age 70 or older

  • you break a bone after age 50

  • you’re a post-menopausal woman younger than 65 with risk factors

  • you’re a man age 50 to 69 with risk factors

It’s important to know that there aren’t official recommendations for bone density testing in transgender women, transgender men, or gender non-conforming people. Still, some medical professionals recommend that regardless of birth-assigned sex: 

  • all transgender people begin bone density screening at age 65 

  • transgender people who have an increased risk for osteoporosis begin screening between the ages of 50 and 64

It’s important to talk to your doctor about your personal risk of osteoporosis and ask when you should start bone mineral testing.

No matter your age, if your breast cancer treatment plan includes therapies that may affect your bone health, you can expect your doctor to recommend: 

  • a baseline DEXA scan before you start treatment

  • regular DEXA scans during treatment

The scan results can help you and your doctor make sure your bones stay strong and take immediate steps if your bone density starts to drop.

 

Osteoporosis and osteopenia symptoms

Osteopenia and osteoporosis typically have no symptoms, especially in the early stages. Many people don’t realize they have low bone density until they break a bone. As you get older, it makes sense to watch out for the following signs that could mean you have osteopenia or osteoporosis:

  • losing an inch or more of height over time

  • stooping or bending forward

  • back pain

  • a bone that breaks much more easily than expected — from bending over or coughing, for example

 

Treating osteoporosis and osteopenia

Doctors commonly recommend certain lifestyle changes and medicine to treat osteoporosis and osteopenia.

Learn more about treating osteoporosis and osteopenia.

Written by: Jamie DePolo, senior editor

— Last updated on September 23, 2022, 8:06 PM

Reviewed by 1 medical adviser
 
Brian Wojciechowski, MD
Crozer Health System, Philadelphia area, PA
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