If your bone mineral density test indicates osteopenia -- a warning sign for osteoporosis -- should you begin treatment? In this article, Johns Hopkins researchers offer advice -- and it may surprise you.
If you've ever had your bone mineral density tested, you may have been given your score -- more precisely, your T score. The T score is drawn from the world of statistics; it reflects the number of standard deviations a person's bone mineral density (BMD) is above or below the norm. In this instance, the "norm" is the BMD of an average, healthy young woman.
If your T score is -1 or higher, your BMD is considered normal; if it's -2.5 or less, you have osteoporosis. But if you fall in between, you have osteopenia. The World Health Organization developed these parameters.
Osteopenia sounds serious -- but is it? Technically, osteopenia is not in and of itself a disease, as osteoporosis is. Instead, osteopenia is an indication that your BMD is below the statistical norm and that you could eventually develop osteoporosis or be at risk of a future fracture. If you have osteopenia, the real difficulty comes in determining whether you need treatment with any bone-building medications.
On one hand, treating osteopenia sounds logical. Osteoporosis doesn't develop overnight, out of the blue; surely, a person with the disease was osteopenic at some point along the line. However, just because you have osteopenia doesn't mean that you're absolutely guaranteed to develop osteoporosis, nor are you fated to have a serious fracture. Thus, taking bisphosphonates or other bone-building medications for your osteopenia means that you might be treated for a condition you never would have developed even if left untreated.
As a result, many experts argue that most people with osteopenia don't need treatment, that blanket prescribing of bone-building drugs for osteopenia is more about alleviating anxiety than actually preventing fractures -- and that such a strategy makes no sense when drug costs and potential side effects are taken into account. Instead, the general consensus is in favor of selective, targeted treatment for osteopenia -- that is, treatment that considers the whole person rather than just the T score.
You and your neighbor might have the exact same osteopenic T-score, but that doesn't mean that you have the exact same risk profile for developing osteoporosis or breaking a bone in the future. BMD is only one of many factors in your individual risk profile. Other factors include: your age, history of personal fractures, family history of osteoporosis, whether or not you're underweight or smoke, whether you're starting treatment with certain drugs, particularly glucocorticoids, or you have another illness that could compromise your BMD.
Whether or not you are prescribed medication for your osteopenia, it's worth regarding osteopenia as a "wake-up call" and taking steps to be sure you're doing all you can to be as healthy as possible. If you smoke, stop. And be sure to get plenty of weight-bearing exercise, enough calcium and vitamin D, and to limit alcohol and caffeine intake.