Ten million Americans have osteoporosis, a skeletal disease that weakens bones, but four times as many people have osteopenia and are at risk of developing it. Defined as low bone density, osteopenia can worsen over time and is best managed when caught early.

Detection of these “silent diseases” can be difficult, though, said Dr. Matthew Levy, medical director of Novant Health Osteoporosis Clinics and an endocrinologist at Novant Health Triad Endocrine – Greensboro.

"Osteoporosis is a disease that you will only notice when it's too late. It doesn't cause pain or any other symptom until there is a fracture,"

Levy said.

Dr. Matthew Levy
Dr. Matthew Levy
Take hip fractures, for example, which hospitalize at least 300,000 people 65 and older each year. Afterward, many are not able to live on their own and are even more likely to die sooner, studies show.

The biggest takeaway, Levy said, is to focus on preserving the bone density you have. “We can lower the risk of a fracture (before it happens) by either building up or strengthening what bone density someone has now," he added.

What's the difference between osteopenia and osteoporosis?

Someone with osteopenia has a below-average bone mineral density (BMD), but not low enough to meet the criteria for osteoporosis. BMD is the amount of bone mineral in bone tissue, and those with fewer minerals have weaker bones.

Osteoporosis is a more advanced stage of low bone density. Literally meaning “porous bone,” osteoporosis is a disease that weakens bones so much that even a minor fall or bump can cause a fracture.

Not everyone with osteopenia gets osteoporosis, but it can happen. However, the risk for fracture is already elevated with osteopenia. That’s why, Levy said, it’s important to take charge of the diagnosis.

picture of a bone

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Who is most at risk for osteopenia?

Osteopenia is usually associated with people over 50, and women are four times more likely to develop it than men.

“Women have lower bone density than men overall. Also, bone loss accelerates greatly with the hormone changes that happen with menopause,” Levy said.

In both men and women, the following groups are also at higher risk:

  • People with a family history of osteoporosis.
  • Medical conditions that require long-term steroid use, such as prednisone.
  • People who take PPIs (medications that treat acid reflux).
  • Women with a long-term use of Depo-Provera injections as their method of birth control.
  • Certain lifestyle factors, such as smoking or excessive alcohol use.
  • Having a mother who went through early menopause (before age 45).
  • People with diabetes or rheumatoid arthritis.

How is low bone density diagnosed?

Bone density is measured with a painless imaging test known as dual-energy X-ray absorptiometry (DEXA). DEXA uses X-rays to determine a person's current bone density and provides a baseline measurement that is compared to future results.

The U.S. Preventive Services Task Force recommends that all women age 65 and older get a bone density test. Men can wait until they’re 70, Levy said, but anyone who is high risk should talk to their doctor about getting one sooner.

The test is short, between 15 and 30 minutes. Cost varies based on insurance, but it’s covered under Medicare for people 65 and older.

What should I expect with a bone density test?

Patients are advised not to wear metal. “No jewelry, zippers or buttons … casual clothing is absolutely fine,” Levy said.

The person will lie on a lightly padded table as a skilled technician scans different area of the body like the back, hips and spine.

“Bone density scans are like specialized X-rays. A small mechanical arm goes above the site that could be imaged. You don’t have to worry about claustrophobia,” he said.

I have low bone density. Now what?

Blood work and an initial consultation with a specialist like Levy can determine how it’s treated. In some cases, low bone density can be managed with a balanced diet and exercise, as well as calcium and vitamin D supplements. This resource explains how much you need – and what to look for in a supplement.

For people with more advanced osteopenia (or osteoporosis), doctors may suggest a more robust treatment plan.

"There may be other risk factors besides menopause causing osteopenia or osteoporosis. So, we perform a full evaluation at the Novant Health Osteoporosis Clinic to find and treat secondary causes of bone loss,"

Levy said

In many cases, a tablet taken once a week or once a month is used to stabilize bone density. Other non-oral medications may be recommended if tablets can’t be tolerated, or osteoporosis is severe.

“Medications that strengthen bone may be recommended for patients with osteopenia. Other treatments that build up bone up are used when the osteoporosis is severe or an osteoporotic fracture has already occurred,” Levy said.

Healthy bones at every age

There are things people can do throughout their life to promote healthy bones:

  1. Eat a calcium-rich diet. Calcium is the mineral in bones (and teeth) that keeps them strong. Dairy products such as milk, yogurt and cheese are high in calcium. Beans and certain green vegetables, like collard greens and kale, also pack a calcium-rich punch.
  2. Get enough vitamin D through sources like sunlight, supplements and food. Without it, our bodies cannot effectively absorb calcium.
  3. Studies have shown a direct correlation between tobacco use and decreased bone density. Do not smoke, or cut back as much as possible, Levy said.
  4. Don’t drink alcohol in excess as it can also compromise bone health.
  5. Know your health history and make your doctor aware if low bone density runs in the family.
  6. Exercise regularly. Weight-bearing activities (jumping rope, low-impact aerobics or using the elliptical) and muscle-strengthening exercises (elastic bands, light weightlifting and yoga) can build and maintain bone density. This resource can help and, as always, consult your doctor before trying something new.