Causes, symptoms and treatments for osteopenia of the lumbar spine

Osteopenia is a bone condition characterized by decreased bone density, which leads to weakened bones and an increased risk of fracture. Osteopenia and osteoporosis are related conditions. The difference between osteopenia and osteoporosis is that with osteopenia, bone loss is not as severe as with osteoporosis. This means that individuals with osteopenia are more susceptible to bone fractures than people with normal bone density, but less so than those who have osteoporosis.

Osteomalacia and osteomyelitis osteoarthritis are often confused with osteopenia, since they sound somewhat similar. Osteomalacia is a disorder of the mineralization of newly formed bone, resulting in weakened bones and a susceptibility to fracture. There are many causes of osteomalacia, including vitamin D deficiency and low blood phosphate levels. Osteoarthritis is inflammatory changes in the joints caused by degenerative changes in cartilage tissue, which does not cause

osteopenia, osteoporosis or decreased bone mineral density.

Patients with osteopenia are not as susceptible to bone fractures as patients with osteoporosis, however, because there are many more people with osteopenia than with osteoporosis, given the large number of patients, the number of fractures can be significant.

Approximately 50% of Caucasian women experience bone fractures during their lifetime. Bone fractures due to osteopenia and osteoporosis are important because they can be very painful, although vertebral compression fractures may not be painful. In addition to pain, such as hip fractures, serious problems arise because these fractures require surgery, and almost 30% of patients with hip fractures require long-term nursing care.

Hip fractures, especially in the elderly, are associated with high mortality. Approximately 20% of people die within a year of a hip fracture due to complications such as thrombosis, congestive pneumonia and other complications caused by immobility of patients. For example, healthcare losses due to fractures associated with osteopenia and osteoporosis in the United States reach $15 billion. Due to the aging population, the number of hip fractures will increase.

Causes of osteopenia

As we age, bones become thinner and this is a natural involutionary process, since starting from middle age, the processes of destruction of bone cells begin to prevail over the processes of formation of new bone tissue. When this happens, bones lose minerals, bone mass decreases, bone structure weakens, and the risk of fractures increases. All people begin to lose bone mass after reaching their peak bone growth (at age 30). And the thicker your bones were at age 30, the longer it takes for osteopenia or osteoporosis to develop.

Some people can have osteopenia without bone loss . They just may have lower bone density to begin with. Osteopenia can result from a variety of conditions or diseases. Women are much more likely to develop osteopenia and osteoporosis than men. This occurs because women have a lower peak bone density by age 30 and because bone loss accelerates as a result of hormonal changes that occur during menopause.

But, nevertheless, older men also need to periodically check their bone density, since a decrease in testosterone levels also contributes to bone loss and a decrease in bone density.

There are many reasons for the development of osteopenia. Common causes and risk factors include:

• Genetic background (family predisposition to osteopenia or osteoporosis);
• Hormonal causes, including decreased levels of estrogen (for example, in postmenopausal women) or testosterone;
• Smoking
• Alcohol abuse
• Diet low in calcium and vitamin D.
• Belonging to the European race
• Subtle physique
• Prolonged immobility
• Long-term use of corticosteroids such as prednisolone or hydrocortisone for inflammation or anticonvulsants such as carbamazepine (Tegretol), phenytoin (Dilantin) or gabapentin (Neurontin)
• Impaired absorption of minerals (for example, with celiac disease);
• Chronic inflammation due to disease (eg rheumatoid arthritis).
• Chemotherapy
• Exposure to radiation

Features of osteopenia and statistics

Osteoporosis is more dangerous to your health because it has a greater impact on bone density and therefore increases the likelihood of a fracture. However, statistics show that there are many more people diagnosed with osteopenia than those who suffer from osteoporosis. That is why, purely statistically, the number of fractures from osteopenia is several times higher than the similar indicators of osteoporosis.

Research shows that about half of all Caucasian women will break a bone at least once during their lifetime. In the modern world, a simple fracture is not a very dangerous problem, because the level of medicine is high enough to properly treat it, and also recover from it.

But fractures associated with osteopenia or osteoporosis occupy a special place in these statistics, because they are almost always more painful and require a more difficult recovery period.

Why are statistics for women shown? It's quite simple - osteopenia occurs equally in both women and men, but taking into account physical characteristics and modern lifestyle, women with similar diseases are more prone to fractures, and the weaker muscular skeleton is to blame.

Fractures of large bones are especially difficult to bear, as they not only take a long time to heal, but also greatly hinder a person’s actions at this time. One of these fractures is damage to the femoral neck, which peaks in the winter season, when there are a lot of slippery places outside. In addition to physical discomfort, there is a more serious side - problems within the body. Such a fracture often causes thrombosis or even varying degrees of pneumonia.

Symptoms

Osteopenia usually does not cause pain as long as there is no bone fracture. In addition, even fractures with osteopenia can be asymptomatic. Osteopenia or osteoporosis may occur for many years before diagnosis. Many bone fractures due to osteoporosis or osteopenia, such as hip fractures or vertebral fractures, are very painful. However, some fractures, especially vertebral fractures, may not be painful, so osteopenia or osteoporosis may not be diagnosed for many years.

Any person who has been diagnosed with osteopenia should make lifestyle changes and work with a doctor to select medication for the correction of osteopenia.

Stages of development of spinal osteoporosis

Diagnostics

The most reliable method for diagnosing osteopenia is densitometry using devices using dual energy X-ray absorptiometry. A bone density scan is performed in the hip, spine and sometimes the wrist. These zones were chosen because they are where

Most often there are bone fractures. Densitometry is a very accurate research method for predicting possible future fractures. Other methods for measuring bone density are quantitative computed tomography (QCT) as well as quantitative ultrasound densitometry. Sometimes plain x-rays reveal diffuse osteopenia or osteopenia in a specific location, such as the spine. Periarticular osteopenia is an indicator of inflammation around a specific joint. This picture can be observed, for example, with rheumatoid arthritis, and this does not mean that there is a decrease in bone density of the entire skeleton. But radiography allows only a qualitative assessment of the presence of a decrease in bone tissue density, and densitometry allows one to determine quantitative indicators of a decrease in bone mineral density. Densitometry is indicated for the following group of people:

• Women age 55 and older and men age 70 and older
• Women and men aged 50-69 years at increased risk of osteoporosis
• Adults who have bone fractures after age 50
• Adults with medical conditions associated with bone loss (such as rheumatoid arthritis) or those taking medications that may cause bone loss (such as prednisone or other steroids)
• Patients receiving treatment for osteopenia or osteoporosis to monitor treatment results

Run from osteoporosis!

The symptoms and causes of osteopenia show that metabolism is responsible for the disease, which tells us how to protect ourselves from troubles. A nutritious diet and sufficient physical activity will help. The necessary products are listed above; you can read about the exercises on our website. In addition, it is worth getting rid of bad habits: they disrupt mineral metabolism.

Let us repeat in simple words what osteopenia is: it is a disorder of mineral metabolism, which in the future can lead to osteoporosis and frequent fractures. But in the early stages it is reversible.

Treatment of osteopenia

The presence of osteopenia requires lifestyle changes and ensuring a diet with sufficient calcium and vitamin D in the diet. Treating an underlying malabsorption disorder, such as celiac disease, can increase bone density. Not every patient with osteopenia requires specialized drug treatment, since not all patients have osteopenia that leads to bone fractures or develops into osteoporosis, and long-term use of specialized medications that have side effects can lead to unwanted complications.

However, if osteopenia is present, your doctor may prescribe medication. The decision on the choice of treatment tactics is made in each specific case on an individual basis, depending on the characteristics of the individual person. Taking into account all risk factors (the presence of genetic risk factors, an initially thin physique, the presence of chronic somatic diseases), the doctor determines the risk of fractures in the next 10 years and selects treatment. The diagnosis of osteopenia is a serious call to make certain lifestyle changes. Lifestyle changes are an important part of preventing and treating osteopenia . These lifestyle changes include regular exercise (such as walking or lifting weights), stopping smoking, moderating alcohol consumption, and ensuring adequate daily intake of calcium and vitamin D. If the diet is not adequate, supplements may be considered.

Vitamin D

• 800 IU (international units) per day for women over age 71
• 600 IU per day for women, other age groups, men and children
• 400 IU per day for children under 12 months of age

Calcium

• 1,200 mg (milligrams) per day for adult women over 50 and men 71 and older. Calcium must be taken in fractions, no more than 600 mg at a time, which
  will ensure optimal intestinal absorption.
• 1000 mg per day for women over 45 years of age and men over 55 years of age.

Specialized medications for the treatment of osteopenia and osteoporosis

• Bisphosphonates (including alendronate [Fosamax], risedronate [Actonel], ibandronate [Boniva], and zoledronic acid [Reclast])
• Calcitonin (Miacalcin, Fortical, Calcimar)
• Teriparatide (Forteo)
• Denosumab (Prolia)
• Hormone replacement therapy with estrogen and progesterone
• Raloxifene (Evista)

Alendronate (Fosamax), risedronate (Actonel), zoledronic acid (Reclast), and raloxifene (Evista) are also prescribed for the prevention and treatment of osteoporosis.

Side effects of alendronate (Fosamax) and other bisphosphonates (risedronate, zoledronic acid and ibandronate) have certain characteristics (for example, avascular necrosis of the jaw), but are quite rare. Typically, these drugs are used only when the benefits of preventing bone fractures significantly outweigh the possible risk of side effects from the drugs.

Osteopenia often does not require treatment with medications. In such cases, it is necessary to dynamically monitor bone density using densitometry.

Prevention of osteopenia

The best way to prevent the development of osteopenia is a healthy lifestyle. Prevention includes ensuring adequate calcium intake through diet or supplementation, ensuring adequate vitamin D intake, reducing alcohol consumption, avoiding smoking, and getting adequate exercise. At a young age, it is necessary to take measures to strengthen bone tissue, since bone density reaches its maximum by the age of 30.

If a person is over 30 years old, it is not too late to make lifestyle changes. A balanced diet and regular exercise will help slow bone loss, delay the development of osteopenia, and delay or prevent the development of osteoporosis.

Drug treatments for osteoporosis

When the diagnosis has already been confirmed and bone density has been proven to be reduced, the doctor selects special medications:

• calcium supplements to stop the loss of bone density;
• bisphosphonates, which prevent bone loss;
• anabolic agents that strengthen bones;
• antiresorptive drugs that stop spinal deformation;
• supplements that contain vitamin D, as well as both vitamin D and calcium.