What is osteopenia? And does osteoporosis affect younger adults?

Bone health is an important part of general health and research has shown that certain medical conditions and specific medications can lead to poor bone health. These issues should be investigated by your doctor to check there is no impact on your bones. While osteoporosis is commonly investigated in adults over 50 years it can occur in younger adults with specific risk factors. At any age if an issue is identified then action can be taken to protect your bone health.

Osteopenia – what is it?

Bone health and strength is commonly investigated with a bone density test which is a simple scan. This requires a doctors referral and is usually recommended for people with risk factors for osteoporosis.

The result from a bone density test includes a T-score. A result between -1 and -2.5 is considered to be osteopenia or ‘low bone density’ range.  This range varies as it sits between a normal result and osteoporosis result.

Adults identified with osteopenia will be recommended to focus on their bone health and ensure adequate calcium, vitamin D and appropriate exercise to support bone health. Doctors will monitor bone health over time and re-test bone density to ensure there is no change or worsening of the result. Doctors may also review medical conditions or medications which may be impacting bone health and take action to reduce any impact.

Action may be taken to protect your bone health depending on age, the level of bone density and any ongoing risk factors for osteoporosis.

What about osteopenia and a fracture?

For anyone over 50 years who sustains a fracture (from a minor incident, fall or from tripping) and is found to have low bone density (T-score -1.5 or lower) a doctor or specialist will typically take action to protect bone health with mediation. This is because a fracture combined with low bone density in this range is considered by doctors to be ‘clinical osteoporosis’.

Can osteoporosis affect younger adults?

While osteoporosis is mainly associated with adults later in life, it can affect young people depending on certain risk factors. Specific health conditions and medications can directly lead to osteoporosis in younger people. These include:

• Anorexia nervosa
• Undiagnosed coeliac disease
• Certain breast cancer treatments
• Early menopause or low testosterone
• Certain thyroid conditions
• Severe lack of calcium in the daily diet or very low vitamin D levels
• Childhood asthma that requires ongoing use of corticosteroids
• Certain medications for epilepsy
• Smoking / excessive alcohol intake

These specific risk factors should lead to a discussion with a GP or specialist about any potential impact on your bone health. If required, a bone density scan or blood test may be arranged by your doctor to review your bone health. Further action may be taken to protect your bone health, depending on the results.

Pregnancy associated osteoporosis

Pregnancy associated osteoporosis (also called transient osteoporosis in pregnancy) is a rare condition. The causes are unclear, and more research is needed to understand this condition.

Woman affected can potentially break a bone easily during pregnancy or in the weeks following the birth. These breaks normally occur in the spine and sometimes the hip. This can be painful and debilitating at the time – however patients do heal, and pregnancy related osteoporosis is short-lived, and most women do not have similar issues in later pregnancies.

There is uncertainty as to why some women are more susceptible to this rare osteoporosis condition during pregnancy. Some women may already have low bone density before they become pregnant (as a result of another disease, medication or lifestyle issues) and the increase in bone metabolism that occur naturally in pregnancy adds stress to the skeleton. Pregnancy also places more demands on the skeleton’s ‘calcium bank.

Because this is rare the diagnosis can be delayed.

This is because osteoporosis is not suspected during pregnancy and may only be investigated after a fracture occurs. Most fractures in pregnancy associated osteoporosis, occur during or soon after the birth. Symptoms, such as serious back pain, are also quite common during pregnancy for other reasons, so doctors may not suspect a fracture caused by osteoporosis.

Also X-rays and bone scans routinely used to diagnose osteoporosis are usually avoided during pregnancy. Even after the baby is born, it may take some time for a diagnosis to occur as the pain associated with fracture may be mistaken for post-pregnancy and labour aches.

Calcium, Vitamin D and Exercise for maintaining bone health in younger adults

It is a well-known that adequate calcium, vitamin D and appropriate exercise is recommended for bone health at all stages of life – from growing bones in children, to maintaining bone health in young adults and also protecting against osteoporosis in older adults.

How much calcium is needed?

For women aged 19 years to 49 years 1,000 mg per day is recommended.

For men aged 29 years to 69 years 1,000 mg per day is recommended.

(note: after these ages recommended levels increase).

Adding calcium to your daily diet is easy because calcium is available in different types of foods and can be easily added to meals to get a calcium boost.

Why is vitamin D important?

The short answer is vitamin D helps absorb the calcium you eat! Therefore, low or deficient levels of vitamin D can be problematic to your bone health.

What is the exercise story?

Any type of exercise can be beneficial to your general health. But when it comes to your bones specific types of exercise are best. This includes a combination of weight bearing and resistance exercise (and for older adults balance exercises as well).