What is the best and safest treatment for osteopenia

If you have osteopenia, you have lower bone density than normal. Your bone density peaks when you’re about 35 years old.

Bone mineral density (BMD) is the measurement of how much bone mineral is in your bones. Your BMD estimates the chances of breaking a bone from a normal activity. People who have osteopenia have a lower BMD than normal, but it’s not a disease.

However, having osteopenia does increase your chances of developing osteoporosis. This bone disease causes fractures, stooped posture, and can lead to severe pain and loss of height.

You can take action to prevent osteopenia. The right exercise and food choices may help keep your bones strong. If you have osteopenia, ask your doctor about how you can improve and prevent worsening so you can avoid osteoporosis.

Osteopenia doesn’t usually cause symptoms. Losing bone density doesn’t cause pain.

Aging is the most common risk factor for osteopenia. After your bone mass peaks, your body breaks down old bone faster than it builds new bone. That means you lose some bone density.

Women lose bone more quickly after menopause, due to lower estrogen levels. If you lose too much, your bone mass may drop low enough to be considered osteopenia.

About half of Americans older than age 50 get osteopenia. The more of these risk factors you have, the higher your risk is:

• being female
• a family history of low BMD
• being older than age 50
• menopause before age 45
• removal of ovaries before menopause
• not getting enough exercise
• a diet lacking calcium and vitamin D
• smoking or using other forms of tobacco
• drinking too much alcohol or caffeine
• taking prednisone or phenytoin

Certain other conditions can also increase your risk of developing osteopenia:

• anorexia
• bulimia
• Cushing’s syndrome
• hyperparathyroidism
• hyperthyroidism
• inflammatory conditions like rheumatoid arthritis, lupus, or Crohn’s

Who should be tested for osteopenia?

The National Osteoporosis Foundation recommends that you have your BMD tested if you’re:

• a woman age 65 or older
• younger than 65, postmenopausal, and have one or more risk factors
• postmenopausal and you’ve broken a bone from a normal activity, like pushing a chair to stand up or vacuuming

Your doctor may recommend that you have your BMD tested for other reasons. For instance, about one in three white and Asian men older than age 50 have low bone density.

DEXA test

Dual energy X-ray absorptiometry, called DEXA or DXA, is the most common way to measure BMD. It’s also known as a bone mineral density test. It uses X-rays that have lower radiation than a typical X-ray. The test is painless.

DEXA usually measures bone density levels in your spine, hip, wrist, finger, shin, or heel. DEXA compares the density of your bone to the density of a 30-year-old’s of the same sex and race. The result of a DEXA is a T-score, which your doctor can use to diagnose you.

If your T-score shows you have osteopenia, your DEXA report may include your FRAX score. If it doesn’t, your doctor can calculate it.

The FRAX tool uses your bone density and other risk factors to estimate your risk of breaking your hip, spine, forearm, or shoulder within the next 10 years.

Your doctor may also use your FRAX score to help make decisions about treatment for osteopenia.

The goal of treatment is to keep osteopenia from progressing into osteoporosis.

The first part of treatment involves diet and exercise choices. The risk of breaking a bone when you have osteopenia is fairly small, so doctors don’t usually prescribe medicine unless your BMD is close to the osteoporosis level.

Your healthcare professional might talk to you about taking a calcium or vitamin D supplement, although generally it’s better to get enough of each from your diet.

To get enough calcium and vitamin D, eat dairy products such as cheese, milk, and yogurt. Some types of orange juice, breads, and cereals are fortified with calcium and vitamin D. Other foods with calcium include:

• dried beans
• broccoli
• wild freshwater salmon
• spinach

The goal for people with osteoporosis is 1,200 milligrams of calcium a day and 800 international units (IU) of vitamin D. However, it isn’t clear whether this is the same for osteopenia.

Walking, jumping, or running at least 30 minutes on most days will strengthen your bones if you have osteopenia, are a young adult, or are a premenopausal female.

These are all examples of weight-bearing exercises, which means you do them with your feet touching the ground. While swimming and biking may help your heart and build muscles, they don’t build bones.

Even small increases in BMD can significantly reduce your risk for fractures later in life.

However, as you get older, it becomes harder for you to build bone. With age, your exercise should emphasize muscle strengthening and balance as well.

Walking is still great, but now swimming and biking count, too. These exercises can help reduce your chances of falling.

Talk with your doctor about the best and safest exercises for you.

In addition to walking or other exercise, try these strengthening exercises:

Hip abductors

Hip abductors strengthen your hips and improve balance. Do this 2 to 3 times a week.

1. Stand tall with your right side facing a chair, holding onto the back of the chair with right hand.
2. Put left hand on top of your pelvis and raise left leg to the side, keeping it straight.
3. Keep toe pointed forward. Don’t raise so high that your pelvis rises.
4. Lower leg. Repeat 10 times.
5. Change sides and do the same exercise 10 times with your right leg.

Toe and heel raises

Toe raises and heel raises strengthen lower legs and improve balance. Do them each day. Wear shoes for this exercise if you have pain in your feet.

1. Stand tall facing the back of a chair. Lightly hold onto it with one or both hands to stay balanced. Work up to being able to stay balanced using just one hand or a few fingers.
2. Keep heels on ground and lift toes off floor. Keep standing straight with knees straight.
3. Hold for 5 seconds. Then lower toes.
4. Now rise up on toes and hold for 5 seconds.
5. Slowly lower heels back to the floor and repeat 10 times.

Prone leg lifts

Prone leg lifts strengthen your lower back and buttocks and stretch the front of your thighs. Do this exercise 2 to 3 times a week.

1. Lie on your stomach on a mat on the floor or on a firm bed, with a pillow underneath abdomen.
2. Rest head on arms, or put a rolled-up towel under forehead. You can also put a rolled towel under each shoulder and under your feet if you like.
3. Take a deep breath, gently press your pelvis against the pillow, and squeeze your buttocks.
4. Slowly raise one thigh off the floor, with knee slightly bent. Hold for a count of 2, keeping foot relaxed.
5. Lower thigh and hip back to ground.
6. Repeat 10 times, then do 10 with the other leg.

The best way to prevent osteopenia is to avoid the behaviors that cause it. If you already smoke or drink a lot of alcohol or caffeine, stop — especially if you’re younger than age 35, when you can still build bone.

If you’re older than age 65, your doctor will likely suggest a DEXA scan at least once to look for bone loss.

People of all ages can help their bones stay strong by maintaining a healthy diet, making sure they get enough calcium and vitamin D. In addition to food, another way to get vitamin D is with a small amount of sun exposure. Talk with your doctor about safe sun exposure based on your other health conditions.