Osteopenia

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You probably know someone who has been diagnosed with osteopenia -- or you have received this common diagnosis yourself. To many women, the word sounds scary... but all it really means is that your bones are somewhat less dense than those of a normal young woman. It does not indicate that you have the level of bone loss associated with osteoporosis, nor that you are prone to having fractures in the near future. Problem: Too often, osteopenia is treated as if it were a serious disease. This has led millions of women who are only in their 50s or 60s to take medication to prevent further bone loss -- even though hip fractures do not occur until age 81, on average... and even though certain bone-building drugs appear to be linked to an increased risk for blood clots, heart-rhythm irregularities and, ironically, thighbone fractures and jawbone degeneration.

Such over-treatment is even more disturbing considering that the majority of women in their 50s have osteopenia -- meaning that their bone density is 10% to 20% lower than that of an average 25-year-old. Endocrinologist Bruce Ettinger, MD, of the University of California Medical Center, San Francisco, told me, "An X-ray test called a DEXA (dual-energy X-ray absorptiometry) is used to measure a person’s bone density and compare it to that of an average 25-year-old -- but of course a woman in midlife or beyond isn’t going to have the bones of a 25-year-old." Reason: A woman’s bone density typically peaks between the ages of 25 and 30, and after that it slowly decreases for the remainder of her life. So bone-density scores that are slightly off are totally normal in your 50s.

The DEXA result is called a T-score. The average T-score of a 25- to 30-year-old woman is 0.0. Having a T-score of -2.5 indicates 25% lower bone density and is the beginning of the range at which osteoporosis is diagnosed. At this level, treatment is indeed often warranted. The controversy arises when the T-score is -1 to -2.4, which is the osteopenia range.

Breakthrough: Two new online risk-assessment questionnaires are helping counteract the assumption that osteopenia automatically requires treatment beyond the usual bone-building strategies of doing regular weight-bearing exercise and getting enough calcium. How: By giving a more accurate sense of an individual’s risk of experiencing a fracture of the hip or other bone within the next 10 years. Instead of relying solely on a woman’s DEXA T-score to determine the need for medication, these tools help doctors and patients gauge the relative importance of various other factors that affect bone health, including age, height and weight... lifestyle (alcohol use, smoking)... ethnicity... personal health history and medication use... and family history.

Bottom line: The National Osteoporosis Foundation concluded that medication is appropriate only if risk assessment reveals that a woman has a hip fracture risk of at least 3% or an overall fracture risk of at least 20% over the next 10 years.

What to do: Take either or both of these online risk-assessment tests yourself -- they are free and simple to use and generally provide similar feedback. (Where the questionnaires ask for your "femoral neck BMD," fill in your DEXA T-score if you know it -- otherwise, leave it blank.) Then discuss your results with your doctor...

  • For the World Health Organization "FRAX" fracture risk-assessment tool, go to www.shef.ac.uk/FRAX and click on "Calculation Tool."

Source: Bruce Ettinger, MD, is emeritus clinical professor of medicine at the University of California Medical Center, San Francisco, and adjunct investigator, division of research, Kaiser Permanente Medical Care Program for Northern California. A graduate of Harvard Medical School and past president of the North American Menopause Society, Dr. Ettinger spent 33 years practicing endocrinology and internal medicine. He has authored or coauthored more than 200 journal articles, primarily on osteoporosis.

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