What is osteopenia of the femoral neck

Several technologies can assess bone density, but the most common is known as dual energy x-ray absorptiometry (DEXA). For this procedure, a machine sends x-rays through bones in order to calculate bone density. The process is quick, taking only five minutes. And it's simple: you lie on a table while a scanner passes over your body. While this technology can measure bone density at any spot in the body, it is usually used to measure it at the lumbar spine (in the lower back), hip (a specific site in the hip near the hip joint), and femoral neck (the top of the thighbone, or femur). DEXA accomplishes this with only one-tenth of the radiation exposure of a standard chest x-ray and is considered the gold standard for osteoporosis screening—though ultrasound, which uses sound waves to measure bone mineral density at the heel, shin, or finger, is also used at health fairs and in some medical offices.

The DEXA scan or ultrasound will give you a number called a T-score, which represents how close you are to average peak bone density. The World Health Organization has established the following classification system for bone density:

• If your T-score is –1 or greater: your bone density is considered normal.

• If your T-score is between –1 and –2.5: you have low bone density, known as osteopenia, but not osteoporosis.

• If your T-score is –2.5 or less: you have osteoporosis, even if you haven't yet broken a bone.

Image: izusek/Getty Images

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Odds are you’ve heard of osteoporosis. This disorder of the bones breaks down bone tissue, causing them to become fragile and more likely to break. It’s a widespread problem that many adults don’t discover until they already have it. But what you may not have heard of is a related condition called osteopenia. So what is it, and how is it related?

Osteopenia is a similar problem, just a lesser version of it. People with osteopenia have low bone density, which means their bones aren’t as strong as they should be, but the bone loss is not as severe as it is in osteoporosis. However, osteopenia can lead to osteoporosis, which is why it’s so important to identify if a person has the disorder before it gets worse.

HSS endocrinologist Jessica Rachel Starr, MD, is a specialist in bone health and metabolic bone disease. Here, she shares five things to know about low bone density to keep your bones strong.

1. The basis for osteopenia forms early in life.

One of the major causes of low bone density is when a person does not reach peak bone mass, or the amount of bone they should have by a certain age. In men, this typically happens in their 20s; for women, in their 30s. Many factors influence how much bone a person builds over time, including their diet; the type of exercise they do (or don’t do); some stomach-related issues that affect the body’s ability to absorb calcium, like celiac disease; and heredity, as some people are genetically inclined to build less bone than others.

“Often patients feel guilty or blame themselves for low bone density, but it is not an individual’s fault if they fail to achieve a robust peak bone mass,” says Dr. Starr.

2. Aging accelerates bone loss.

This one isn’t as surprising, but it is the truth: As we get older, our bones become more frail. It’s perfectly possible that someone develops the proper peak bone mass but loses that mass over time as they age—which sets them up for developing osteopenia and, later, osteoporosis.

“Often, people don’t know they have an issue with bone loss until they fall and break a bone,” says Dr. Starr. “Osteopenia and osteoporosis don’t cause pain or mobility issues on their own.”

One possible indicator that something may be awry is height; if you find yourself shrinking in your later years, it may be due to bone loss. “People lose an average of an inch in height as they age, but if it’s more than that, it could signal a problem,” she adds.

3. Your habits can affect your risk.

If you’re a smoker or a heavy drinker, it’s likely that you’re damaging your bones. According to the National Institutes of Health, studies have shown a direct link between tobacco use and decreased bone density.

On the bright side, good habits can also influence the health of your bones. Eating dark, leafy greens, fish and dairy products and taking a vitamin D supplement can help you keep your bone density at its peak for as long as possible.

4. Bone density testing can be a crucial tool in diagnosis.

During bone density testing, low-energy X-rays are used to see the calcium content of a person’s bones. This is compared to both healthy young adults and people of the same age and sex as the person having the test. Usually, the tests are done on the lower (lumbar) spine, hips and wrist, as these are the likeliest areas for bones to break.

Bone density testing is used to diagnose osteoporosis, but it can also diagnose osteopenia. “Bone density testing at HSS can also tell us about bone quality and help assess how advanced a person’s osteopenia really is,” says Dr. Starr.

Treatment for low bone density depends on the person, how much bone loss they have and if they’re at a higher risk for fracture. If that’s the case, there are medicines that can help reduce bone breakdown and build up the skeleton as much as possible, says Dr. Starr.

5. You may be able to prevent osteopenia from turning into osteoporosis.

Just because you have osteopenia doesn’t mean your bones are doomed to lose more mass, says Dr. Starr. There are several simple, straightforward steps you can take to shore up what you’ve got.

The first and most important of these is weight-bearing exercise. Examples run the gamut—anything from running, hiking and dancing to sports like tennis. Lifting light weights is also a great option. The point is to expose your bones to more stress than they would be under during daily activities like walking, driving or going about your usual routine.

For women, hormone therapy within the 10 years after a final menstrual period has also been clinically proven to prevent osteoporosis and reduce the risk of bone fractures. “In fact, the use of hormone therapy just for the purposes of preventing osteoporosis is approved by the FDA,” says Dr. Starr. Of course, talk to your doctor before beginning any type of hormone therapy routine.

Smoking and Bone Health | NIH Osteoporosis and Related Bone Diseases National Resource Center

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