Osteopenia Osteopenia is defined as the loss of bone density caused by the inability of the body to produce enough bone to keep up with normal bone destruction. While osteopenia is similar to osteoporosis, osteoporosis is a more severe degree of bone loss that causes bones to become weak, brittle, and highly prone to fracture. On the other hand, osteoarthritis is a condition in which joints and cartilage are affected by painful inflammation and calcium deposits. Signs and Symptoms The signs and symptoms of osteopenia are very similar to those of osteoporosis and may include: Back pain Height loss, curving spine Broken bones Tooth loss What Causes It? Although many people think of the skeleton as an unchanging structure, bones are living growing tissues. Bone consists of a strong, flexible mesh of collagen fibers (proteins that form a soft framework) and calcium phosphate (a mineral that hardens the framework). Throughout a person's lifetime, new bone is added to the skeleton and old bone is removed. During the early years of life, new bone is added faster than old bone is removed. As a result, bones become larger, stronger, and more dense until they reach peak bone mass (maximum bone density and strength). Peak bone mass tends to occur between the ages of 30 and 35. After this age, however, the bones lose increasing amounts of protein and minerals-more than they can build up-and the bones become thin and porous. The same is true for menopausal women. During menopause, estrogen levels drop. Studies have shown that this female hormone helps protect against bone loss. Without the protective effects of estrogen, menopausal women are at an increased risk for developing osteopenia. Other than age and menopause, causes of osteopenia can include: Long term use of certain medications, particularly steroids, antibiotics, drugs that suppress the immune system, and thyroid medications Cushing's syndrome (a condition caused by an excess of a steroid hormone called cortisol) Kidney failure Diseases of the thyroid or adrenal glands Deficiencies in calcium, vitamin D, vitamin A, vitamin K, and/or magnesium Hypogonadism (abnormally diminished function of the sexual organs such as the testes in men) Elevated levels of prolactin (a hormone responsible for lactation) Alcoholism Rheumatoid arthritis Epilepsy Severe lung illness Rare genetic disorders such as osteogenesis imperfecta, Ehlers-Danlos syndrome, and Marfan's syndrome Diabetes mellitus Depression Risk Factors Advanced age (50 years or older) Being of European or Asian ancestry Being female Living a sedentary lifestyle Being thin Family history of osteopenia or osteoporosis Never having menstruated or given birth to a child Late onset of menstruation or early menopause Heavy caffeine use, smoking cigarettes, and/or drinking alcohol regularly Low exposure to sunlight High exposure to heavy metals (such as cadmium, copper, and lead) What to Expect at Your Provider's Office Conventionally accepted medical approaches of assessment for this condition may include a bone mineral density test (BMD) to determine whether your bone mass is below, at, or above normal levels. BMDs are painless, noninvasive, and safe. They typically measure bone density in the spine, wrist, or hip, while others measure bone in the heel or hand. Generally, osteopenia is present when bone density at the hip is between 0.664 and 0.826 grams/square centimeters. Having accurate BMD measurements will help your healthcare provider determine an effective treatment approach. Under the concepts of functional medicine, assessment is oriented toward determining what is impeding your body's ability to function normally. While some of the conventional medical approaches may help in this determination, they may not necessarily apply to a functional approach. Your healthcare provider will determine which assessment tools are most helpful in establishing a treatment strategy specific to your health needs. Treatment Options Treatment Plan While there is no cure for osteopenia, it is possible to avoid certain risk factors by incorporating the following lifestyle changes: Staying active and getting plenty of exercise Supplementing your diet with extra calcium, magnesium, and vitamins A, D, and K Quitting smoking Reducing alcohol, caffeine, and soft drink intake Complementary and Alternative Therapies In addition to necessary lifestyle and dietary alterations, several complementary and alternative therapies may aid in the prevention and/or treatment of osteopenia. Nutrition Eating fruits and vegetables and consuming adequate amounts of calcium and vitamin D are crucial in the prevention of ostepenia. Keeping bones healthy throughout life depends on getting sufficient amounts of specific vitamins and minerals, including phosphorus, magnesium, boron, manganese, copper, zinc, folate, and vitamins B12, B6, C, and K. Avoiding sodium, alcohol, and caffeine may also enhance bone health. Calcium An inadequate supply of calcium over the lifetime is thought to play a significant role in contributing to the development of osteopenia. In fact, many studies have shown that low intakes of calcium are associated with low bone mass and rapid bone loss. According to the National Institutes of Health, many Americans consume less than half the amount of calcium recommended to build and maintain healthy bones. Recommended intakes of calcium for the prevention and/or treatment of osteopenia are as follows: Children: 800 to 1,200 mg per day Adolescent girls: 1,200 to 1,500 mg per day Premenopausal women (19 to 50 years old): 1,000 mg per day Older adults (51 to 70 years old): 1,200 to 1,500 mg per day Good dietary sources of calcium include low fat dairy products (such as milk, yogurt, and cheese), dark green, leafy vegetables (such as broccoli, collard greens, and spinach), sardines, salmon, tofu, and almonds. Since most people have difficulty obtaining the recommended amounts of calcium from their diets alone, supplements may be an effective addition. Because there are several different types of calcium and a variety of supplements available, your healthcare provider can help you choose the most appropriate supplement for you. Vitamin D Vitamin D plays a major role in calcium absorption (calcium must be absorbed into the bloodstream in order to have an effect on the body) and bone health. Vitamin D supplements and/or exposure to the sun (about 20 minutes a day), in combination with calcium, can help reduce the risk of bone loss. Recommended intakes of vitamin D for the prevention and/or treatment of osteopenia are as follows: Older adults (51 to 70 years old): 400 IU/day; (71 years and older): 600 IU/day Isoflavones Found primarily in soy products, isoflavones have been shown to increase bone density and slow bone loss in menopausal women. Results from several studies suggest that, in the years leading up to menopause, women may decrease their risk of osteopenia by consuming soy products rich in isoflavones. Ipriflavone Ipriflavone, a synthetic isoflavone derived from natural isoflavones found in soy, red clover, and other food sources, may also be effective in preventing and treating osteopenia. Several studies have found that ipriflavone prevents bone loss and increases bone density in menopausal women. Essential Fatty Acids A deficiency in essential fatty acids such as gamma-linolenic acid (GLA), found in evening primrose oil, and eicosapentaenoic acid (EPA), found in fish oil, can lead to osteopenia. Studies have shown that supplements containing essential fatty acids help maintain or increase bone mass. Essential fatty acids have also been shown to enhance calcium absorption, increase calcium deposits in bones, diminish calcium loss in urine, improve bone strength, and enhance bone growth. Foods rich in essential fatty acids (including coldwater fish such as salmon and mackerel) may confer the same benefits. Vitamin K Studies show that women who consume vitamin K supplements may improve bone density. The current recommended daily intake of vitamin K for adults is 75 to 120 micrograms, but some researchers suggest that higher dosages may be necessary for optimal bone health. Be sure to consult with your healthcare provider to determine the most appropriate dosage for you. Herbs The following herbal remedies may help support the prevention and treatment of osteopenia (particularly in postmenopausal women): Black cohosh (Cimicifuga racemosa)-contains phytoestrogens (estrogen-like substances that help protect against bone loss) Chasteberry (Vitex agnus-castus)-used traditionally for menstrual and perimenopausal symptoms; may also prove to have benefits for preventing or treating osteopenia Red clover (Trifolium pratense)-contains isoflavones that may slow bone loss in women Wild yam (Dioscorea villosa)-may be beneficial for menopausal symptoms and osteopenia Horsetail (Equisetum arvense)-contains substances believed to strengthen bone Kelp-rich in minerals that may be an effective complementary treatment for osteopenia Acupuncture Traditional Chinese Medicine (TCM) practitioners generally treat osteopenia with acupuncture. According to traditional Chinese beliefs, the kidney governs bone and stores the qi (energy) for bone and marrow. Osteopenia occurs when the bone marrow is no longer nourished, and according to TCM, this results from exhaustion of kidney Yin energy. Therefore, the acupuncturist would energize the qi at points that stimulate kidney energy. Massage Massage and/or meditation may offer relaxation, positive thinking, and stress relief benefits for patients with osteopenia. Chiropractic Possible complications associated with alcoholism include mental confusion or delirium, severe amnesia, an unsteady gait, and loss of sperm cells, as well as ailments resulting from repeated, violent vomiting. Typically, there are periods of remission followed by periods of abuse. Life expectancy is decreased by about 15 years. About a fifth of alcoholics permanently abstain. During pregnancy, abstinence from alcohol is the only completely safe measure. Following Up It is important to visit your healthcare provider on a regular basis in order to receive updated BMD tests. People taking blood-thinning medications, such as warfarin, should avoid vitamin K. It is important to note that very high intake of vitamin A may actually increase the risk of osteopenia. As with any nutritional supplement or herbal therapy, talk to you healthcare provider before initial use. Supporting Research Andon MB, et al. Supplementation trials with calcium citrate malate: evidence in favor of increasing the calcium RDA during childhood and adolescence. J Nutr 1994;124(8Suppl):1412S-17S. Brzezinski A, Debi A. Phytoestrogens: the "natural" selective estrogen receptor modulators?Eur J Obstet Gynecol1999;85(1):47-51. Gennari C, Adami S, Agnusdei D, et al. Effect of chronic treatment with ipriflavone in postmenopausal women with low bone mass. Calcif Tissue Int1997;61(1Suppl):S19-22. Guillaume G. Postmenopausal osteoporosis and Chinese medicine. Am J Acupuncture 1992;20:105-11. Prince R. The calcium controversy revisited: implications of new data. Med J Aust 1993;159(6):404-7. Smith EL, et al. Calcium supplementation and bone loss in middle-aged women.Am J Clin Nutr1989;50(4):833-42. Ushiroyama T, et al. Efficacy of ipriflavone and 1-alpha vitamin D therapy for the cessation of vertebral bone loss. Int J Gynecol Obstet1995;48(3):283-88. Valente M, et al. Effects of 1-year treatment with ipriflavone on bone in postmenopausal women with low bone mass. Calcif Tissue Int1994;54(4):377-80. Wallach S. Effects of magnesium on skeletal metabolism. J Am Coll Nutr1989;8:457A. Copyright © 2001 OneMedicine The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.