Osteopenia, now called low bone mass, is a term used to describe lower-than-normal bone density or thickness. Approximately 44 million adults in the United States have osteopenia.The condition is different than osteoporosis, which is a disease where normal bone structure becomes thinned out and porous.

Low bone mass can occur at any age, but noticeable and significant bone loss is most likely to occur in women during the 5 to 7 years following menopause. This group is also more likely to experience a bone fracture than someone with normal bone mass.

What is Osteopenia?

Low bone mass is a condition that develops when a person:

  • May naturally have less-dense bones due to factors such as body size, genetics, or gender.
  • Has gradually lost bone mass over time due to lack of exercise and poor diet.
  • Has begun to experience perimenopause, symptoms that signal the onset of menopause or who is in menopause.
  • Has rapidly lost bone mass due to an illness or use of medication.

How Is It Diagnosed?

Low bone mass is diagnosed through a quick and painless specialized scan ordered by aphysician. If you are seeing a physical therapist for rehabilitation, the therapist may confer with your physician when detecting a possible need for bone testing.

The results of the scan are reported using T- and Z-scores.

The T-score compares your score to that of healthy 30-year-old women. A T-score between -1 and -2.49 means that you have low bone mass. Those who have a T-score of -2.5 and lower have osteoporosis.

If you have a T score of -1 or less, you have a greater risk of experiencing a fracture. A person with a T-score of -2 has lower bone density than a person with -1.

The Z-score compares your bone mineral density to the average of peoplewho are of the same age, sex,weight,and race as you. A Z-score of -2 or lower might mean that something other than normal bone loss due to age is occurring. Your doctor will likely explore other health issues that might be causing the bone loss.

Other methods of screening bone density include x-ray, ultrasound, and CT scan.If you have risk factors that includecertain diseases, short- or long-term use of steroids, or a recent bone fracture, a DXA scan may be prescribed.

How Can a Physical Therapist Help?

A physical therapist can help you prevent and treat low bone massat any age by prescribing the specific amount and type of exercise that best builds and maintains strong bones.

When you see your physical therapist, the therapist will review your health history, including your medical, family, medication, exercise, dietary, and hormonal history. Your physical therapistwill also conduct a complete physical therapy examination and identify your risk factors for low bone density.

It is important to exercise throughout life, and especially when you have been diagnosed with low bone mass in order to build and maintain healthy bones. Exercise can help to build bone or slow the loss of bone.

Your physical therapist is likely to prescribe 2types of exercise that are best to build strong bones:

Weight-bearing Exercises

  • Dancing
  • Walking at a quick pace (122-160 steps per minute or 2.6 steps per second)
  • Jumping, stomping, heel drops
  • Running at least a 10-minute mile
  • Racket sports

Resistance Exercises

  • Weightlifting
  • Use of resistance bands
  • Gravity-resistance exercises (pushups, yoga, stair climbing, etc.)

Your physical therapist will design an individual exercise program for you based on your particular needs. Your physical therapist will test you to see how much resistance is needed and is safe for your specific bone density as well asother physical issues that you may have. Treatment starts at the level you can tolerate. Once you learn how to perform your program, your physical therapist may add more strenuous activity with physical effort to encourage your bones to grow stronger.

Your exercise prescription will include guidelines for weightbearing and resistance training for the hips, spine, shoulders, and wrists. The therapist will prescribe guidelines for the intensity, frequency, and progression of your exercises.

Exercise is only 1component of healthy bones. Your physical therapist will encourage you to pursue a healthy and varied diet, including foods rich in calcium, to reach the amount recommended according to your age and health status. Your physical therapist may recommend that you meet with a dietitian to learn about the many foods that contribute to bone health. Sometimes, medication or hormone replacement therapy may be recommended. Your physician will help guide you to find the best combination of exercise, diet, and medication to treat your condition.

Can this Injury or Condition be Prevented?

Risk factors that you can avoid in order to lower your chances of developing low bone mass include:

  • Cigarette smoking
  • Excessive alcohol intake (greater than 1 drink per day for women, 2 per day for men)
  • Poor diet
  • Low calcium and Vitamin D levels        
  • Sedentary or low level activity—less than 5,000 steps per day