Osteopenia and Osteonecrosis

Osteopenia is the thinning of bone mass. While this decrease in bone mass is not usually considered "severe", it is considered a very serious risk factor for the development of osteoporosis. Osteopenia is commonly seen in people over age 50 that have lower than average bone density but do not have osteoporosis. The diagnostic difference between osteopenia and osteoporosis is the measure of bone mineral density.

Osteonecrosis is the "fragile bone disease," is characterized by a loss of bone mass caused by a deficiency in calcium, vitamin D, magnesium and other vitamins and minerals. If it progresses, osteoporosis can lead to loss of height, stooped posture, humpback, and severe pain. According to the National Osteoporosis Foundation, osteoporosis affects 10 million Americans, mostly women. Thirty-four million more Americans are estimated to have osteopenia (low bone mass), putting them at risk for osteoporosis.

 Fact About Osteoporosis

  • Osteoporosis affects 44 million Americans (California's population is around
    34 million) at a cost of $17 billion dollars annually.
  • One out of two women and one out of eight men will be affected by
    osteoporosis in their lifetime.
  • Having osteoporosis puts people at higher risk for fractures that are painful,
    can be disfiguring, and reduce their ability to lead active lives.
  • In a recent study, one half of all women over 50 years old had osteoporosis
    or low bone mass and did not know it.
  • Only 35% of American adults consume the recommended daily allowance of calcium.
  • An estimated 14 million men in the United States currently have low
    bone mass or osteoporosis.
  • Osteoporosis is treatable and may be preventable.
  • People need to know their risk for osteoporosis and talk to their doctors about
    diagnosis, prevention, and treatment strategies.

 Symptoms of osteonecrosis include:

  • Pain in the affected area of the body
  • Limited range of motion, joint stiffness, or limping muscle spasms
  • Progressive bone damage leading to bone collapse

 What is the Treatment for Osteonecrosis?

While some treatments may provide relief from the pain associated with osteonecrosis, surgical removal of the dead bone and joint replacement are the only effective treatments for people who have serious osteonecrosis. If you are diagnosed with osteonecrosis, you may benefit from:

  • Surgery - options range from minor outpatient procedures to reinforce bone,
    to partial or total hip replacement.
  • Medications - non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin
    or ibuprofen may decrease the pain of osteonecrosis.
  • Assistive devices - canes, crutches, or a walker may lesson the pain associated
    with bone disorders and may reduce the risk of falls.

 How Doctors Determine the Difference

Bone mineral density (BMD) is the measurement of calcium levels in bones, which can estimate the risk of bone fractures. It is also used to determine if a patient has osteopenia or osteoporosis. Bone mineral density tests are non-invasive and painless procedures usually done on the hip, spine, wrist, finger, shin bone, or heel.

While osteopenia can be diagnosed using plain radiographs, the most common method for measuring BMD (and a way to definitively diagnose osteoporosis) is through Dual Energy X-ray Absorptiometry or DEXA. This scan uses low-energy x-rays that expose patients to much less radiation than standard x-rays and can assess calcium levels in bone. The results are measured as a "score" and are compared to those of healthy individuals.

 Who Is At Risk?

Not everyone will get osteopenia or osteoporosis. However there are certain risk factors that can increase the likelihood that a person will have moderate to severe loss of bone mass, including the following:

  • Gender - women are a higher risk because they have less bone mass than men.
    Women also often experience a loss of bone mass after menopause.
  • Race - Asian and Caucasian women, especially those who are small-boned,
    are at highest risk.
  • Family history - patients with a family history of low bone mass have a 50%-85% increased risk of developing osteoporosis.
  • Age - most people (men and women) lose about .5% of bone mass every
    year after the age of 50.
  • Lifestyle choices - including poor diet with a lack of calcium and vitamin D, smoking, excessive use of alcohol or caffeine, and lack of exercise contribute to a loss
    of bone mass.
  • Other medical conditions - such as hyperthyroidism, hyperparathyroidism, and
    Cushing's syndrome, can contribute to bone loss. Certain medications (such as prednisone or phenytoin), are known to cause bone loss as well.


While most people experience some loss of bone mass as they age, osteopenia and osteoporosis are not inevitable parts of the aging process. There are things that can be done to keep bones healthy, including the following:

  • Maintain a healthy diet with adequate amounts of calcium, magnesium,
    vitamins D, K, and C as well as other minerals.
  • Regular physical activity that includes weight bearing exercises, such as
    low-impact aerobics, jogging, and walking to help minimize bone loss.
  • Avoidance of smoking and excessive use of alcohol.
  • Regular check-ups with a physician to monitor bone loss, especially
    in people over age 50.
  • Use of medications to help improve bone health if deficiencies in
    bone mass are detected.

 Some things you can do to lower your risk of bone problems:

Consume adequate calcium and vitamin D in your diet - High-calcium foods include low-fat milk, yogurt, and leafy green vegetables. Calcium supplements with vitamin D are another source of calcium. Adults should consume 1,000 to 1,500 mg of calcium each day.

  • Get weight-bearing exercise - Walking, jogging, playing tennis, dancing, and other physical activities strengthen bone.
  • Don't drink excessive alcohol or smoke - These behaviors accelerate bone loss.
  • Prevent falls - Bone breaks or fractures increase your risk of osteonecrosis

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