Osteopenia - should I be worried?

[India1]

I had a letter today from my gastroenterologist telling me I have osteopenia. Is this something I should be worried by or is it not a big deal as long as I increase my calcium intake?

[InVivo]

Osteopenia means your bone mineral density is lower than normal. It is considered by many doctors to be the precursor to osteoporosis as a high percentage of people diagnosed with osteopenia go on to develop osteoporosis.

It is common in coeliacs, as the minerals and nutrients needed for healthy bone growth are affected by impaired gut function.

Calcium is well known in relation to bones, but your bones need a lot more than calcium alone, and the other nutrients required are just as important.

The role of Vitamin D in bone health is better understood recently, but did you know that you also need Magnesium, Boron, vitamin K, B vitamins , Potassium, vitamin C and a group of antioxidants called carotenoids.

Osteopenia isn't a reason to panic, but it does need to be taken seriously.

[Irene Administrator in reply to InVivo]

Great points.

In addition we'd recommed that:

a) you ask your Gastro for more information (they should write to you and your GP explaining what it means AND advise on what follow up treatment you have).

b) follow up with your GP and ask them to ensure that your vitamin levels are checked eg vitamin D blood test plus others. You may need the Vitamin D injection vs Calci-Chew tablets as often whilst the stomach is healing the Vitamins won't be absorbed correctly.

Do also note that almost all Vitamin D prescribed supplements in the UK contain sorbitol, aspartamene or maltodextrin. The two former ones are know to be harder for patients with stomach problems to absorb and dietitians often recommend avoiding them as they can be stomach irritants. Coeliac UK confirm that maltodextrin from wheat in prescribed medicine is within levels Coeliacs should be able to tolerate. FYI it is often hard currently to source the vitamin D injections as there has been a shortage of supply with these. So have a good chat with your GP/ Gastro ref next steps and the best way to manage the Osteopenia.

c) do ask for a follow up as well to monitor your vitamin levels and bone density in future so you have a way forward.

Keep us updated.

<b>Updated on Sep 22 2010 12:23AM:</b> Handy reading:

patient.co.uk/leaflets/oste...

nos.org.uk/NetCommunity/Pag...

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It is also important to have a well balanced calcium rich diet to provide all the nutrients your bones need, and to make sure you get enough vitamin D.

There are a number of steps a person diagnosed with osteopenia can take to ensure that their bones do not deteriorate further, including a healthy diet, regular weight bearing exercise, cutting down on caffeine and alcohol consumption, and giving up smoking."

osteopenia3.com/Osteopenia-...

[InVivo in reply to InVivo]

Because Vit D is a fat soluble nutrient, it is possible to buy it in an oil suspension and take drops rather than tablets. There are forms available that are not expensive, and are formulated to be absorbed by those with impaired digestion. Look in health food shops such as Revital or the Nutri Centre. Both of these stores have online sites.

Because bone health is more complicated than calcium alone, and in fact just taking or eating calcium can make things worse in some cases, I've started writing a blog post about it, for a more comprehensive look at the subject.

[philaustin in reply to InVivo]

I was told by my doctor that osteopenia was a mild, early stage of osteoporosis. (so that's nothing to worry about really is it)

When I went for a diving medical the dive doc told me this is wrong. He reckoned that I had osteoporosis, and that osteopenia is a kind of generic name covering a bunch of problems.

Can anyone here validate this?

Also, I have to take an alendronic acid tablet once a week, 1/2 hour before eating, with a full glass of water, and remain upright for 1/2 hr.

I was told that this stuff retains bone cells that are old and would otherwise be ekected by the body, in order to retain bone structure.

I have 2 x 600mg Calcium +D3 every day.

[FionaGFG Administrator in reply to InVivo]

Philip,

Here's a short summary between Osteopenia and Osteoporosis:

1. Osteopenia = early signs of bone loss i.e. bone mineral density is lower than normal. However, it is not yet low enough to be considered osteoporosis. Yet it can develop into Osteoporosis. Decreased oestrogen levels may be the cause of low bone mass or osteopenia.

*so in a way your diving doc is correct as this is broad brush term for a variety of bone mineral density issues.

Note: Osteopenia can turn into osteoporosis if it is not diagnosed early and promptly treated.

2. Osteoperosis = Osteoporosis is the most common bone disease. It weakens bones and increases the risk of unexpected fractures which can lead to problems.

So what next...

HOW IS OSTEOPENIA DIAGNOSED?

Two tests are required:

1. Bone density: this check defines the thickness of your bone.

2. Bone mass: this test checks how much bone you have.

DEXA

Now when you were first diagnosed with Coeliac Disease you should have also had a DEXA bone scan which would asses any bone damage.

The most accurate way to diagnose osteopenia and osteoporosis is through bone mineral density testing. This is usually done with a dual-energy X-ray absorptiometry (DEXA) scan.

DEXA scan results are reported as T-scores:

* Normal bone: T-score above -1

* Osteopenia: T-score between -1 and -2.5

* Osteoporosis: T-score below -2.5

"Other tests can be done to help diagnose osteoporosis and osteopenia. Quantitative ultrasound is one such test. It measures the speed of sound in the bone to assess bone density and strength. DEXA scans are usually still needed to confirm results from ultrasound and other tests." WebMD

1. Bone density:

Your GP/ Gastro Dr can check for this by measuring the levels of minerals in your bones. These minerals include:

* Calcium

* Phosphate

* Other minerals

The simple rule here is :

The denser the content of your bone mineral is, the stronger your bones are.

Aging:

As we age our bodies absorbs back calcium and other minerals from our bones. This re-absorption can make your bones weaker and lead to osteopenia and osteoporosis. The bones become more vulnerable to fractures and other damage.

FYI: As Coeliacs there is some research that says CD attacks bones and increases this aging process and other research that says our stomach damage also causes problems in absorbing the vitamins and minerals we need for healthy bones. So as we begin to heal internally on a GF diet the absorption of vitamins and minerals (eg vit D, Calcium) should increase. Yet for many Coeliacs this can take years e.g. 3 years of low levels so that's why we're often given the Vit D and Calcium supplements. It's part protection and part insurance against Osteoporosis.

Note: These should be part of your regular 6monthly/ yearly MOT Coeliac Tests with the Gastro team (or your GP). If you've never had these checked - get booking your appointment with your Doc to request them!

ARE YOU AT RISK?

As explained there are strong research links between Osteoporosis and Coeliac Disease.

Plus these factors can increase your risk:

- Coeliac Disease!

- Menopause (you're ok here Phil!)

- Alcohol consumption (this also affects iron absorption)

- Age 30yrs + and we begin to lose bone density

- Lack of exercise (often high impact sports are recommended to strengthen bones)

- Smokers

- Steroid users

- Chronic medical problems e.g. rheumatoid arthritis, malabsorption , malnutrition, premature menopause, hyperthyroidism, hypogonadism insulin dependent diabetes or chronic liver disease (+ CD!)

However, the problem with bone issues is that they're often hard to detect yourself. It's not until you have an injury and have an X-ray that you're aware of them.

WHAT CAN YOU DO?

Top tips on Web Med include:

* Eat a balanced diet. Include plenty of calcium and vitamin D. You'll find these nutrients in foods like milk, yoghurt, cheese and broccoli.

NOTE: especially important for CD people, as we're often not absorbing these properly even when when our stomach;s have healed.

* Exercise regularly. Choose weight-bearing exercise like walking, running or tennis. Also do strength training using weights or resistance bands.

* Avoid smoking.

* If you drink, do so in moderation.

Hope that helps.