Osteopenia has no recognizable symptoms. There is no noticeable pain or change as bone becomes thinner. However, the risk of fractures is increased due to reduced bone density.

Osteoporosis remains asymptomatic until skeletal fragility is announced with a fracture. The clinical evidence of osteoporosis depends on which bones are involved. Thoracic and lumbar vertebral fractures are extremely common and produce loss of height and various deformities; including kyphoscoliosis that can compromise respiratory functions [4]. Pulmonary embolism and pneumonia are common complications of fracture of the femoral neck, pelvis or spine. They cause as many as 50,000 deaths annually.

• Collapse

  Osteoporosis can also lead to curvature of the spine from vertebral collapse. Maintaining strong, healthy bones is critical to your body's overall health. [obesityhelp.com]

  It can also lead to stooped posture, loss of height, and a collapsed vertebra. According to the National Osteoporosis Foundation, about 54 million people in the United States have osteoporosis. Many more people are estimated to have osteopenia. [medicalnewstoday.com]

  We have shown pronounced anterior vertebral collapse in 26% of 66 patients investigated for this potential complication. [thorax.bmj.com]

• Weight Gain

  Bone structure and body weight : Petite and thin women have higher chances for the disease, too. Weight loss after age 50 in women also seems to raise the chance of hip fractures, while weight gain lowers it. [webmd.com]

  Women over 65 can still take it but may prefer alternatives because of problems such as bleeding, breast tenderness and weight gain. [diagnose-me.com]

  Weight losses after the age of 50 in women increases the risk of hip fracture, while weight gains decreases this risk.22,23 Menopause was also a risk factor with statistical significance in our study. [scielo.br]

  History Pertinent medical history Chronic medical disorders (e.g., CP, malabsorption syndromes, renal or liver disease) Endocrine disorders Pain in a limb or joint Previous fractures Nutrition history Significant weight gain or loss Typical daily food [now.aapmr.org]

• Anemia

  Intestinal disorders - malabsorption, Lactose intolerance, Liver disease, Low birth weight, Lupus, Lyme disease, Multiple Sclerosis, Multiple myeloma, Osteo-genesis imperfect, Organ transplants, Peridontal disease (Peridontitis), Post Polio, Sickle Cell anemia [osteopenia3.com]

  The usefulness of routine small bowel biopsies in evaluation of iron deficiency anemia. J Clin Gastroenterol 2004; 38: 756-760. 9. Zamani F, Mohamadnejad M, Shakeri R, et al. [dsgh.dk]

  All patients having anemia were given erythropoietin intravenously (1500-3000 units) after each dialysis session to maintain hematocrit values at about 30%. [sjkdt.org]

  Diagnosis Baseline laboratory studies include the following: Complete blood count: May reveal anemia Serum chemistry levels: Usually normal in persons with primary osteoporosis Liver function tests Thyroid-stimulating hormone level: Thyroid dysfunction [emedicine.medscape.com]

• Epilepsy

  Furthermore it does not ask the user for their history of medication use - epilepsy drugs and antidepressants for example can speed up bone loss. How Is Osteopenia Treated? The treatment for osteopenia is highly controversial. [womens-health-advice.com]

  Vitamin deficiency, Bulimia, Cancer, Celiac disease, Chronic Kidney Disease or Dialysis, Cerebral Palsy, Chronic Obstructive Pulmonary Disease (COPD), Crohn’s disease, Chronic inflammation (such as in arthritis) Colitis, Cushings syndrome, Diabetes, Epilepsy [osteopenia3.com]

  American Epilepsy Society, and American Neuropsychiatric Association Disclosure: Nothing to disclose. [medscape.com]

  Common Causes of Secondary Osteoporosis Medical conditions Central nervous system disorders (e.g., epilepsy, multiple sclerosis, Parkinson disease, spinal cord injury, stroke) Chronic obstructive pulmonary disease Endocrine/metabolic disorders (adrenal [aafp.org]

• Prolonged Immobilization

  In general, immobilization causes bone loss (following the 'use it or lose it' rule). For example, localized osteoporosis can occur after prolonged immobilization of a fractured limb in a cast. [en.wikipedia.org]

• Lactose Intolerance

  H igh cholesterol diet, Hyperthyroidism, Hyperparathyroidism, Hypogonadism, IBD (inflammatory bowel disease, Intestinal disorders - malabsorption, Lactose intolerance, Liver disease, Low birth weight, Lupus, Lyme disease, Multiple Sclerosis, Multiple [osteopenia3.com]

  intolerance, celiac disease or malabsorption problems. [diagnose-me.com]

  intolerance or milk allergy may develop osteoporosis due to restrictions of calcium-containing foods. [60] Individuals with bulimia can also develop osteoporosis. [en.wikipedia.org]

• Heart Disease

  It has been shown to reduce spinal fractures, but unlike conventional HRT, it does not increase risk of cancer or heart disease. [whitakerwellness.com]

  A plant-based diet rich in vitamins and minerals not only can keep your bones healthy, it can also prevent and treat other common diseases, including diabetes, heart disease, and cancer. [udemy.com]

  Although yet unclear, some experts suggest that too much calcium especially in supplements can increase the risk of heart disease. [mayoclinic.org]

• Skin Disease

  It's rather like saying a 50 year old has skin disease because she has wrinkles. The WHO said that its definition of osteopenia was never meant as a tool for diagnosis or prescribing drugs. Yet that is what is happening. [womens-health-advice.com]

  For more information about osteoporosis, visit the National Institute of Arthritis and Musculoskeletal and Skin Diseases. [nia.nih.gov]

  Osteoporosis at Curlie Handout on Health: Osteoporosis – US National Institute of Arthritis and Musculoskeletal and Skin Diseases Osteoporosis – l NIH Osteoporosis and Related Bone Diseases – National Resource Center Office of the Surgeon General (2004 [en.wikipedia.org]

• Back Pain

  Common ones include: Sudden, severe back pain Back pain that gets worse when standing or walking, but gets a bit better when you lie down Back pain when bending or twisting Loss of height Curved or stooped shape to your spine You can have had a series [webmd.com]

  Bisphosphonates for the prevention and treatment of osteoporosis BMJ 2015 Osteoporosis: now and the future Lancet 2011 52 yo F with Scleroderma, Raynauds, B12 deficiency is seen for chronic back pain. [imreference.com]

  An 83-year-old woman accompanied by her 56-year-old daughter presents to the office with severe upper back pain over the past 2 days. [accessmedicine.mhmedical.com]

  The following conditions and comorbidities are associated with loss of bone mineral density: - Back pain - Hypertension - Diabetes - Osteoarthritis - RA - COPD - CKD - Asthma - Hyperlipidaemia - Hyperthyroidism - Cushing's syndrome - Pituitary disease [globenewswire.com]

• Bone Pain

  That means that osteopenia is frequently not detected unless a person has a bone density test. When osteopenia does cause symptoms, there may be localized bone pain and weakness in an area of breakage of bone (bone fracture). [emedicinehealth.com]

  Another huge advantage is that these patients often have bone pain and joint pain ... which will be relieved almost immediately after a successful parathyroid operation in about 90-95% of patients. Most claim their bone pain is completely gone. [parathyroid.com]

  Muscle aches & Cramps, Bone pain and Fractures: muscle and bone pain are an indicator of inadequate vitamin D, which is important in bone formation. [livinglovecommunity.com]

• Bone Disorder

  }, volume={19}, pages={3517 - 3523} } A novel approach has been proposed to classify bone disorders for classifying the radiographic bone image as normal, Osteopenia and Osteoporosis. [semanticscholar.org]

  Osteopenia and osteoporosis are two disorders caracterized by bone density loss. Osteopenia has no recognizable symptoms. There is no noticeable pain or change as bone becomes thinner. [symptoma.com]

  Research Into PEMF Therapy for Osteoporosis or Osteopenia Yale University School of Medicine studied the use of PEMFs in arthritis, but also found that they could be useful in the treatment of other bone disorders, including osteoporosis. [drpawluk.com]

  […] over the last 25 years: Osteoporosis, osteopenia, and fracture risk: find the real cause to stop bone loss Osteoporosis is not: Just thin bones Normal aging bone loss A female disorder Something that goes wrong with our bones An isolated disorder Osteoporosis [womenshealthnetwork.com]

  They can also be used to detect other bone disorders and conditions, such as osteopenia, and to measure the relative amounts of body fat and muscle. A DXA scan is a quick and painless way of measuring BMD. [hse.ie]

• Hip Pain

  Review Topic QID: 3199 ML 3 Select Answer to see Preferred Response PREFERRED RESPONSE 4 (OBQ12.169) A 72-year-old woman presents with severe hip pain after stepping off of a curb. She denies any trauma or prior history of hip pain. [orthobullets.com]

  It will also affect knees, hips (pain will be in the groin of the leg and inner aspect of the thigh, not on the side or buttock.) and spine. It can affect your neck and, to a lesser degree, the shoulders. [sonoranspine.com]

  Transient osteoporosis of the hip This is generally a unilateral process, characterized by joint pain, an antalgic limp and limited hip motion. The hip pain begins spontaneously, without an antecedent history of trauma or infection. [rad.washington.edu]

• Paravertebral Muscle Spasm

  muscle spasms exacerbated by activity and decreased by lying supine Patients often remain motionless in bed because of fear of causing an exacerbation of pain Acute pain usually resolves after 4-6 weeks; in the setting of multiple fractures with severe [emedicine.medscape.com]

• Fear

  One family of postures contraindicated for those with osteopenia and osteoporosis are forward bends - for fear of fractures on the anterior (front) portion of the vertebral bodies (irregular bones of the spine). [ekhartyoga.com]

  Worries about bisphosphonates Many people may fear taking bisphosphonates because they’ve heard about two potential serious adverse effects: osteonecrosis of the jaw and atypical fractures. [berkeleywellness.com]

  Fear of fracture “I spend a lot of time allaying concerns among women whose risk of osteoporosis is not high but who worry,” says endocrinologist Bruce Ettinger, M.D., professor emeritus at the University of California, San Francisco. [aarp.org]

The following investigations are required for the diagnosis of osteoporosis.

• Serum alkaline phosphatase: Serum alkaline phosphatase is usually normal but may be elevated especially after fracture.
• Serum calcium and phosphate: The serum levels of calcium and phosphate are normal.
• Serum parathyroid hormone: Serum parathyroid hormones are normal.
• X-rays: X-rays show decreased bone mineral density and may reveal one or more fractures (if present). Demineralization is most apparent in the spine and pelvis as well as the femoral head and neck. Compression of the vertebrae may also be seen.
• Bone densiometry: Bone densiometry is used to determine the density of the spine and hip bones. A score of -2.5 or less is diagnostic of osteoporosis.

The treatment plan in osteoporotic diseases is aimed at the prevention of bony fractures and improving lifestyle [6].
There are various options to treat osteoporotic conditions that are given below:

• Pharmacologic therapy: This approach includes administration of adequate calcium, vitamin D and anti-osteoporotic medication such as bisphosphonates, parathyroid hormone (PTH) and estrogen [7].
• Vertebroplasty and kyphoplasty: These are surgical procedures used for the management of vertebral compression fractures [8].
• Dietary measures: Patients with osteoporosis should take daily doses of 1200-1500mg of calcium and 400-800 IU of vitamin D. Premenopausal women and men younger than 50 years of age (without risk) should receive a total of 1000mg of calcium daily. Postmenopausal women and men older than 50 years of age (with risk of osteoporosis) should receive 1200mg of calcium daily in their diet [9]. 
• Exercise: Aerobic exercises such as walking and bicycling are highly recommended to maintain upright spinal posture include. Certain exercise training programs have positive impact in enhancing strength and maintaining balance of body [10].

The prognosis of osteoporotic diseases is good if the disease is detected in the early phases. Bone mineral density (BMD) is improved and fractures are reduced by proper medical and surgical approaches.

The following factors contribute to osteopenia in both men and women:

• Various nutritional and metabolic disorders that do not allow the body to use sufficient vitamins and minerals can contribute to osteopenia.
• Chemotherapy and drugs such as steroids can also result in osteopenia.
• Exposure to radiation can also lead to osteopenia.

Osteoporosis has endogenous as well as exogenous risk factors, which contribute to primary and secondary osteoporosis respectively.

The endogenous risk factors include:

• Female gender
• Advanced age
• Asian race
• Small stature
• Thin physique
• Family history
• Nulliparity
• Early menopause

The exogenous risk factors include:

• Low calcium intake
• Reduced physical activity
• Cigarette smoking
• Alcohol abuse
• Aluminium antacids
• Steroid therapy

The incidence of osteoporotic lesions is 50% in women and 30% in men. In the United States, more than 10 million persons over age 50 are affected by osteoporosis and approximately 33.6 million people have osteopenia. The annual direct health care cost for osteoporotic lesions is $12 billion to $18 billion.

Bones naturally become thinner as people grow older. All people usually begin losing bone mass after the age of 30. In case of osteopenia, usually in middle age, existing bone cells are reabsorbed by the body faster than new bone is made. As this occurs, the bones lose minerals, becoming weaker with increased risk of fractures.

In osteoporosis, there is an increased bone resorption and reduced bone formation that results in reduced bone mineral density (BMD). In women after menopause, there is rapid reduction in bone mineral density as estrogen production is reduced. Estrogen affects indirectly cytokines and other growth factors in body. Estrogen deficiency thus leads to increased expression of RANKL that results to the recruitment of pro-osteoclasts as well as osteoclasts [3]. In contrast, aging is associated with a decreased supply of osteoblasts in proportion to demand.

Calcium and Vitamin D deficiency on other hand, play an essential role in causing osteoporotic conditions. Reduced calcium levels lead to secondary hyperparathyroidism. Parathyroid hormone in turn increases calcium resorption from bones, making them brittle and porous. Other conditions that lead to bone loss include endocrinal disorders and drugs like glucocorticoids. Corticosteroids inhibit osteoblast function and enhance osteoblast apoptosis.

Primary prevention of the disease starts in childhood with diet enriched in calcium and vitamin D intake. Lifestyle modifications are helpful to some extent. Cigarette smoking, physical inactivity and intake of alcohol must be stopped.

Osteopenia and osteoporosis are the most common metabolic bone disorders affecting over 200 million people worldwide [1]. 

Osteopenia refers to the condition in which the bone mineral density (BMD) is lower than the normal peak level.

Osteoporosis is a skeletal disorder characterized by bone mineral density even lower than that in osteopenia that results in the destruction and fracture of bones. Osteoporosis can be primary or secondary.

• Primary (Idiopathic) osteoporosis: This includes postmenopausal type I and senile osteoporosis type II. The former is due to estrogen deficiency in the body whereas the latter results from advanced age and calcium deficiency.
• Secondary osteoporosis: This may be due to some endocrine diseases, nutritional deficiencies, drugs or metabolic defects in body [2].

Osteopenia and osteoporosis are conditions in which the bones become thin and weak. The chances of fractures therefore, become significantly higher. The disease is more common in older age group and postmenopausal women. Usually there are no symptoms and the disease is detected after a fracture. With proper treatment, diet and lifestyle changes, the disease has a good prognosis.

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2. Ahmed SF, Elmantaser M. Secondary osteoporosis. Endocrine development. 2009;16:170-190.
3. Bono CM, Einhorn TA. Overview of osteoporosis: pathophysiology and determinants of bone strength. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. Oct 2003;12 Suppl 2:S90-96.
4. Lynn SG, Sinaki M, Westerlind KC. Balance characteristics of persons with osteoporosis. Archives of physical medicine and rehabilitation. Mar 1997;78(3):273-277.
5. Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ, 3rd, Khaltaev N. A reference standard for the description of osteoporosis. Bone. Mar 2008;42(3):467-475.
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8. Percutaneous vertebroplasty or kyphoplasty for vertebral fractures caused by osteoporosis. Technology Evaluation Center Assessment Program. Executive summary. Apr 2010;24(7):1-5.
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10. Sinaki M. Exercise for patients with osteoporosis: management of vertebral compression fractures and trunk strengthening for fall prevention. PM & R : the journal of injury, function, and rehabilitation. Nov 2012;4(11):882-888.