November 26, 2016

Do You Know the Difference between Osteopenia and Osteoporosis?

See What You Can You Do to Maintain Good Bone Health Throughout Your lifetime


It is almost common knowledge that our bones grow stronger from childhood, through teenage and young adult years and start declining as one begins to age. While age is a leading agent in depleting bone density, there are various other factors involved. The term used by experts to describe low bone density is Osteopenia. While not an actual diagnosis, Osteopenia is a contributing factor to Osteoporosis-the fragile bone disease. A patient observed with Osteopenia is more likely to develop Osteoporosis. The main difference between Osteopenia and Osteoporosis is the measure of mineral bone density. This post analyses the difference between the two, their symptoms, causes and ways to improve bone health.

The Difference: Bone Mineral Density

Bone mineral density (BMD) is measured in terms of standard deviations (SD) from a healthy young adult. Different BMD measuring tools estimate the ‘standard’ young adult age differently.  Some measures approximate this age to be in the mid-to-late twenties, but most standard measures use a healthy 30 year old as the reference measure. If one’s BMD is between 1 and 2.5 SD below that of a healthy young adult, they are considered to have relatively low bone density (Osteopenia). This does not necessarily indicate bone loss, as one may have not attained peak bone mass in their youth (Kanis, 1990). Osteoporosis occurs when one’s BMD goes beyond 2.5 standard deviations below that of a healthy person. It is characterized by structurally deteriorating fragile bones prone to fracture after low trauma.

Symptoms, Causes and Risk Factors

While bone loss does not easily manifest its symptoms, there are a few tell-tale signs that one’s bone health needs addressing. There are also some ‘at-risk’ populations that are more likely to develop bone loss, and should be wary of the signs. This section addresses the two.

Early Indications of Bone Loss

  1. Receding gums: gums help secure our teeth to the jaw bone. If the jaw starts losing bone, the gums may recede. Studies conducted in women have linked jaw bone loss to reduced BMD in other areas like the vertebral column of the lumbar spine.
  2. Brittle fingernails: While there is no scientific evidence for the association, individuals with a low BMD usually have weak, easily breakable fingernails.
  3. Reduced grip: hand-grip strength is a crucial physical test factor when checking for overall BMD. Patients with severe BMD are usually asked to improve hand grip strength by exercising, as this improves bone health, and reduces risk of fractures by preventing falls.
  4. Muscle aches & Cramps, Bone pain and Fractures: muscle and bone pain are an indicator of inadequate vitamin D, which is important in bone formation. Nocturnal leg cramps normally indicate low blood calcium, magnesium and potassium, and if left unattended, results in bone loss. Low trauma fractures indicate sever bone loss.

Other symptoms include: height loss & poor posture, low fitness levels, tooth loss and manifestation of spinal deformities (Hajime, et al, 2001).

At-Risk Populations

  1. Ladies: women are more likely to develop osteopenia as they generally have lower BMD compared to men. Post-menopausal women are also at a higher risk of bone loss, since they experience a drop in estrogen levels, leading to lower BMD and bone strength.
  2. Those with a family history of bone disease: if a family member has had bone fracture/osteoporosis, then you are more likely to develop osteopenia and osteoporosis.
  3. Those undergoing various forms of medication: various treatments, such as chemotherapy, radiotherapy, acid blockers, certain antidepressants and corticosteroid therapy directly impact bone strength, resulting in a higher chance of fracture and bone loss.
  4. Nutrient deficiency: individuals with inadequate levels of Calcium, Magnesium, Potassium, and Vitamin are at a higher risk of developing osteopenia since these help in the formation and maintenance of healthy bones.
  5. Heavy smokers and drinkers: smoking increases the risk of getting fractures due to weakened bones. Smoking may also result in early onset menopause, thus hastening osteopenia. Excessive consumption of alcohol also raises the likelihood of developing osteoporosis.

Other predisposing factors include: having a slender frame, ageing, eating disorders, excessive exercise, hyperthyroidism, hypopituitarism, lack of physical activity, and diseases like rheumatoid arthritis & breast cancer (Wonke, et al, 1997).

Suggested Remedies

This section discusses various measures one could use to improve bone health and bone density.

  1. Physical Exercise: bones gain strength when utilized. The best workout for bones involves weight-lifting exercises that get the body opposing gravity. These include jogging, walking, dancing, lifting weights and stair climbing.
  2. Diet that promotes stronger bones: in order to improve bone health, experts advise that one includes calcium and vitamin D in their diet. Foods rich in calcium include: dairy products, leafy greens, tahini and fish. The body synthesizes its own vitamin D when the skin is exposed to sunlight. Dietary sources of vitamin D include fish, beef liver, cheese, eggs and dairy products.
  3. Lifestyle choices: individuals are advised to quit smoking and cut back on alcohol as these deplete bone structure. Salt, caffeine and sugar are also huge culprits in bone deformations, and restricting their consumption results in better bone health.
  4. Medical interventions: in case of severe bone loss, there are several medications that reduce deformation. These include: hormonal stimulation of bone formation (Forteo) and calcitonin that raises the BMD. Estrogen replacement therapy also helps reduce the progression of osteopenia (Ego and Eisman, 2004). Black Cohosh is a natural alternative to estrogen replacement. Although no research has been done to explore its estrogenic effect, women in European and Asian tribes that have used the herb in the past report very little incidences of osteoporosis and other post-menopausal symptoms.

While bisphosphonates have been recommended as a medical intervention, research exists that challenges their use. They initially inhibit the bone replacement process, causing dramatic rises in BMD in their first few months of use (Russell, Graham G, 2006). Overtime, bisphosphonates also inhibit the bone growth and resorption processes. The result is dense but weak bones.

  1. Testing and Supplements: Bone specialists should help an individual achieve the optimum amounts of various minerals and nutrients via administration of supplements. These include:
  • Vitamin supplements – D & K are important for healthy bone growth. One way to determine a person’s blood vitamin D levels is the 25-hydroxy vitamin D blood test.  A healthy person should have between 35-60 nanograms/millilitre (ng-ml). If a doctor or functional medicine practitioner determines that one is vitamin D deficient, they may prescribe a vitamin D supplement.  The recommended daily intake is measured in international units (IU), and can range from 600 to 10,000 per day.   In a healthy adult female levels need to continue to be monitored when supplementing so that levels do not go to high.  For individuals deficient in vitamin D, the practitioner recommends vitamin D supplements depending on the amount in the blood and IU offered by the supplement.
  • Minerals- minerals make up about 70% of the bone by weight. These mineral include Magnesium, Calcium and trace minerals such as silicon, strontium, vanadium, zinc, phosphorus, iron and copper (Conrad, et al, 1992). One’s physician should check on the bone mineral status to determine if the person would require mineral supplements. These supplements either promote the production and transportation of the minerals, or are a source of said minerals.
  • Dehydroepiandrosterone (DHEA) – there is strong scientific evidence linking the hormone DHEA to bone strength. Studies conducted to determine bone density in post-menopausal women that received DHEA supplements showed a 1.7 to 2.6% increase in spinal bone density (Zhang, et al, 2016). It is therefore necessary to determine one’s DHEA levels, and take the appropriate DHEA supplements along with Vitamin D and K.


To recap, osteopenia is the relative depletion of bone mineral density while osteoporosis is a disease characterized by progressively weaker bones, bone loss and low-impact fractures. Early symptoms of osteopenia include receding gums, brittle fingernails, reduced grip, easily fractured bones and manifestation of spinal deformities. Bone loss is more likely to affect women, individuals with a genetic predisposition, those undergoing medication, slender individuals and those with eating disorders among others. Suggested remedies for bone deformation include: physical exercise, proper diets, better lifestyle choices and medical interventions.


  1. Kanis, John A. “Osteoporosis and osteopenia.” Journal of bone and mineral research3 (1990): 209-211.
  2. Orimo, Hajime, et al. “Diagnostic criteria for primary osteoporosis: year 2000 revision.” Journal of bone and mineral metabolism5 (2001): 331-337.
  3. Wonke, B., et al. “Genetic and acquired predisposing factors and treatment of osteoporosis in thalassaemia major.” Journal of pediatric endocrinology & metabolism: JPEM11 (1997): 795-801.
  4. Seeman, Ego, and John A. Eisman. “7: Treatment of osteoporosis: why, whom, when and how to treat.” Medical Journal of Australia6 (2004): 298-303.
  5. Russell, R. Graham G. “From Bench to Bedside.” Skeletal Development and Remodelling in Health, Disease and Aging 1068 (2006): 367-401.
  6. Zhang, Na, et al. “DHEA prevents bone loss by suppressing the expansion of CD4+ T cells and TNFa production in the OVX-mouse model for postmenopausal osteoporosis.” Bioscience Trends 10.4 (2016): 277-287.
  7. Shea, M. Kyla, and Sarah L. Booth. “Update on the role of vitamin K in skeletal health.” Nutrition reviews 66.10 (2008): 549-557.
  8. Johnston Jr, C. Conrad, et al. “Calcium supplementation and increases in bone mineral density in children.” New England journal of medicine 327.2 (1992): 82-87.



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