Dat the beginning of menopause, the doctor prescribes MOC or Dexa to evaluate bone density and prevent fractures. So it may happen that the report indicates that your bones are becoming fragile, even though the much feared Osteoporosis has not yet appeared. And the report says “Osteopenia”. Yellow traffic light. But what does it mean? This is a fact that should not be underestimated for health and quality of life in the years to come. There are many and simple things to do, if done with precision and determination. We talked about it with Doctor Alberto Cerasari, Medical Specialist in Sports and Exercise Medicine, Medical Director and Longevity Doctor at SoLongevity Clinic.
What is osteopenia and how many women over 50 does it affect?
Osteopenia is a condition characterized by a reduction in bone mineral density (BMD or BMD in English) below normal values, but not so severe as to be classified as osteoporosis. This is one intermediate stage which indicates a increased risk of developing bone fragility and fractures. The measurement takes place via the T-score value obtained with the bone densitometry (DEXA): we speak of osteopenia for a T-score between -1 and -2.5.
According to statistics, about 30-50% of women over 50 presents osteopenia, especially following menopause, due to the decrease in estrogen, progesterone and testosterone, hormones essential for maintaining bone health.
2. How is it different from osteoporosis?
The main difference lies in the severity of bone loss. Osteopenia is the moderate loss of bone density (T-score between -1 and -2.5). While Osteoporosis is the most serious condition with a T-score lower than -2.5, associated with a very high risk of fractures, even with minor trauma. In other words, theosteopenia is a “predisposing” condition that can progress to osteoporosis if it is not diagnosed and managed adequately.
3. What are the causes?
The main causes of osteopenia include:
Physiological factors: aging, early menopause, genetics.
Hormonal factors: reduced levels of estrogen in women and testosterone in men.
Diet: poor in bone nutrients such as vitamin D, calcium, inadequate protein intake
Sedentary lifestyle: lack of physical activity, especially overload exercises
Medicines: for example, corticosteroids or others that may interfere with bone metabolism or intestinal absorption of nutrients
Harmful habits: smoking, alcohol abuse and excess caffeine.
Illnesses: pathologies such as hypo/hyperthyroidism, intestinal malabsorption or renal failure for example
4. What are the symptoms?
Osteopenia is generally asymptomaticthat is, it does not cause obvious symptoms. However, in some advanced cases it can manifest itself with bone or joint pain (often attributable to other conditions). Even a greater predisposition to micro-fractures can indicate the appearance of osteopenia. Often the diagnosis comes after a routine densitometric examination or after a fracture following a trivial trauma.
5. How to make the diagnosis?
The diagnosis of osteopenia is mainly based on bone densitometry (DEXA). It is a radiological examination that measures bone mineral density (usually on the lumbar spine and femur). The diagnosis is completed with blood tests to evaluate calcium, vitamin D, alkaline phosphatase, thyroid function and parathyroid hormone (PTH) levels. The clinical history is used to identify risk factors such as family history, lifestyle habits, pre-existing diseases or use of medications.
6. Which drugs can cause osteopenia?
Several medications can negatively affect bone density:
Corticosteroids: used for the treatment of chronic inflammation, autoimmune diseases.
Antiepileptics: such as phenytoin and carbamazepine.
Aromatase inhibitors: used in breast cancer therapy.
SSRI antidepressants: some studies highlight a correlation between prolonged use and reduction in bone mass.
Proton pump inhibitors (PPIs): for prolonged treatments of gastroesophageal reflux/gastritis they can cause reduction in absorption of many nutrients also important for the bones.
Everything you need to know to protect your bones and prevent Osteopenia (Getty Images).
7. What to do when diagnosed?
When osteopenia is diagnosed, it is important to take a combined approach. We start from lifestyle modification: increase sun exposure, practice regular physical activity and improve nutrition.
Monitoring: bone densitometry should be done periodically to evaluate the progress. THE’Integration: vitamin D, K2 and calcium if indicated by your doctor. Pharmacological treatments: if the risk of fracture is high, the specialist may prescribe medications such as bisphosphonates or others in selected cases.
8. Which exercises are indicated and how often should they be done?
The physical exercises recommended to combat osteopenia are those that stimulate bone formation:
Fast walking: 30-40 minutes a day, 4-5 times a week.
Resistance exercises (with light weights): at least 2 times a week.
Postural and balance exercises: to reduce the risk of falls.
Yoga or Pilates: to strengthen muscles and bones. Avoid high impact activities or activities that involve sudden movements, such as jumping, which can increase the risk of fractures or excessive twisting of the trunk in the case of more serious forms.
9. Which diet to choose?
Nutrition plays a key role in preventing osteopenia. Here are the six essential things to follow to protect yourself from fractures with diet.
Soccer: with the advice of your doctor, take at least 1,000-1,200 mg per day. It is found in dairy products, green leafy vegetables, almonds, oily fish.
Vitamin D: among the various benefits it helps promote the absorption of calcium (fatty fish, egg yolk, fortified milk).
Proteins: they are essential for muscle and bone health (white meat, fish, eggs, legumes, red meat in moderation).
Reduction of salt and sugars refined in excess: which promote the loss of calcium.
Hydration: drink at least 1.5-2 liters of calcium-rich water a day.
Avoid smoking, alcohol.
10. Which supplements help in case of Osteopenia?
Supplements that may be useful, when recommended by a doctor, include:
Soccer: in case of insufficient food intake.
Vitamin D3: to maintain adequate serum levels and improve calcium absorption.
Vitamin K2: which helps fix calcium in the bones, reducing the risk of accumulation in the arteries.
Magnesium: cofactor in bone metabolism.
Hydrolyzed collagen: helps improve the quality of bone tissue. It is recommended to avoid “do it yourself” intakes and to always follow the specialist’s instructions to avoid excesses or interactions with other drugs.
Boron, Silicon: microelements that work synergistically for bone health
The Benefits of Essential Amino Acids on bone health
The essential amino acids (AAE) play a crucial role in regulation of bone metabolism and in prevention of loss of bone mineral density (BMD)contributing both to the maintenance of bone mass and to the reduction of the risk of osteopenia and osteoporosis. Above all lysine, arginine, methionine and leucine contribute positively to bone health stimulating the formation of osteoblasts, improving calcium absorption and collagen synthesis. These effects make them promising in the prevention and treatment of osteopenia and osteoporosis, especially in combination with adequate calcium and vitamin D intake. Here is an overview based on major scientific studies.
The effect of Essential Amino Acids on Osteoblasts
Arginine and lysine have been shown to increase the proliferation and activity of bone cells (osteoblasts), stimulating collagen synthesis and increasing the production of nitric oxide (NO), important for vascular health and bone density (Source: Torricelli et al., 2003).
Other amino acids such as methionine and tryptophan influence biochemical pathways linked to the formation and differentiation of bone cells (Source: Vijayan et al., 2014).
The protective effect on Osteoporosis due to nutritional deficiencies
Lysine has been shown to increase intestinal calcium absorption and reduce urinary excretion, contributing to a positive calcium balance (Source: Civitelli et al., 1992).
The benefits of the association between amino acids and Bone Mineral Density (BMD)
Studies in monozygotic twins found that higher levels of amino acids such as leucine, alanine, and glycine were associated with greater BMD in the spine and forearm (Jennings et al., 2015).
Even in cases of male idiopathic osteoporosis, higher tryptophan levels were correlated with improved bone density (Pernow et al., 2010)
Integration of essential amino acids in the prevention of osteopenia
A supplementation of AAE, such as arginine and lysine, has shown beneficial effects in osteoblast cultures from osteopenic tissues, increasing markers of bone formation and improving cell differentiation activity (Fini et al., 2001).
The combined administration of proteins with essential amino acids improved collagen synthesis and the production of bone growth factors, such as IGF-1 (Torricelli et al., 2003).
Synthesis and role of collagen in the bone matrix
Essential amino acids contribute to the synthesis of type I collagenmain component of the bone matrix, improving bone strength and reducing the risk of fractures (Conconi et al., 2001).
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