Osteopenia diagnosis from an x ray?: My husband... - Bone Health

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Osteopenia diagnosis from an x ray?

jacdo profile image
13 Replies

My husband recently had an x ray of his foot as he has a lot of pain which he thought was due to his MS, but was worried it could be arthritis as it seemed to be his bones tthat were hurting. He has had a letter today telling him that he has osteopenia. Can this be detected from an x ray? I only ask as mine was diagnosed from a DEXA scan. He did break his other ankle quite badly last year when he fell so it wouldn't surprise me if he did have osteopenia but just didn't think an x ray would show anything.

13 Replies
HeronNS profile image

As far as I can tell, osteopenia, at least as the word is now used to mean bones that are slightly less dense than youthful normal, but not so advanced in thinning as osteoporosis, is not detectable through ordinary x-ray. However, and I can't find it now, if I do I'll post later, I'm sure I heard that the original meaning of osteopenia was indeed something detectable through ordinary x-rays. Indeed, where I live, the hospital where I attended an osteoporosis workshop went to some pains to say that they use the term "low bone mass" instead of osteopenia to avoid confusion.

HeronNS profile image
HeronNS in reply to HeronNS

So all I can find is there needs to be about a 30% bone loss before bone thinning shows up on an x-ray. I wonder if that was the original meaning of osteopenia, bone thinning evident in an x-ray, but the word has changed its meaning to indicate bone thinning not as serious as osteoporosis. Might be good to find out which was meant in your husband's diagnosis.

jacdo profile image
jacdo in reply to HeronNS

Thanks for the information, HeronNS.

I think he will phone his MS specialist to find out what he actually saw on the x ray. It could explain why my husband broke his ankle on both sides from just a simple fall and whether maybe he should have a DEXA scan. I presume that osteoporosis can't be detected from an x ray so how would he konw if he had that?

Thanks again for your help.

Twistandshout profile image

My osteoporosis was spotted as low bone mass from ankle X Ray therefore I think it must be possible. I was then sent for dexa scan where unfortunately it was confirmed

Justme13 profile image
Justme13 in reply to Twistandshout

I was given an X-ray by Gp when I had a lot of pain during chemo. I asked radiographer what he was looking for. He said OP. I said I thought you needed dexa for that. He said if 30% loss, would show. All clear.

Many months later, long story, had dexa, unrelated to the previous pain, and I did have OP.

A long while after that I discovered I had fractured, Oncologist hadn’t told me, as seen on ct scan.

So, X-ray didn’t show fracture nor OP.

It needs to be 30% loss.

Didn’t show my fracture either, probably hairline.

SusanEleven profile image

The short answer: My osteopenia showed on an x-ray after an accident where I slipped and fell hard on a ceramic tile floor, ending up with a compression fracture in my spine.

The really long version: The radiology report talked about osteopenia, bone demineralization, and the radiologist’s worry that I’d progress quickly to “frank osteoporosis”.

This was about 20 years ago. Bone drugs were pushed at me but at the time I’d done a lot of reading about Vitamin D and asked to get my level tested. It was in the “severe deficiency” range. I’d also read negative things about the bone drugs so I refused them. I worked with my endocrinologist to get my D levels normal (We finally sorted out I need 4000 units a day year round of D3 to stay in the normal range!) and made sure I got my calcium and exercise. My bones improved over the course of a few subsequent Dexa scans.

After all these years I finally officially have osteoporosis (-2.5) in my spine. My hip reading is still osteopenia (1.8). I’m not surprised since I’ve been on prednisone for 3+ years so far for PMR and that has an impact. I’m still refusing the bone drugs for now.

Met00 profile image

I'm fairly sure you can't diagnose osteopenia from an x-ray, because, as others have said, bone thinning only shows on x-ray if there's at least 30% bone loss, which is osteoporosis, not osteopenia. So if the x-ray showed bone thinning, it's more likely to be osteoporosis. Also, even if bone thinning does show on x-ray, I thought you still need a DEXA scan to confirm the diagnosis. I was sent for a DEXA after "possible" bone thinning showed on x-ray, which I believe is a more realistic description of what they can/cannot see.

Justme13 profile image
Justme13 in reply to Met00

Yes, to clarify my previous post. Radiographer said if 30% evident, would then arrange dexa.

jacdo profile image

Thanks everyone for your replies. Lots of interesting and useful information.

MiaLee profile image


Five years ago, I also broke my foot, and as it was a ‘Joan’s Fracture’ and difficult to heal, so I had to be off that foot for a period of time. This also caused osteopenia in the foot seen on the xrays. I had to do a lot of weight bearing exercise and build the bone back up. At first I attended physio but then just practised the exercises on my own at home. Weights that strapped around the ankles were used. You can google the exercises easily. So yes, an xray can show bone loss related to non weight bearing due to the fracture. You can build it up again. It takes time and you have to be consistent though otherwise it will stay about the same.

Justme13 profile image

Yes, but only if 30% bone loss or more.

I only had 27% and it didn’t show on x Ray.

mandynelson50 profile image

Osteopenia can be shown on an xray, but osteoporosis cannot be confirmed until a dexa scan is carried out. I attended minor injuries recently as my foot had been extremely painful to walk on for over three weeks. The nurse said that the pain was probably due to osteopenia pain as there was no fracture showing and as it had been painful for over 10 days then a fracture at the start of the pain would show up by then. She didnt have my full history and worked it out herself. A DEXA many years ago confirmed early onset osteoporosis.

MiaLee profile image

Don’t forget, there is controversy regarding these dexa scans; the head of drug policy for BC, Canada presented a paper at the 12th annual conference for drug policy, entitled: ‘On not using Dexa Scans to sell drugs”.

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