What Does "Osteopenia" Really Mean?

[Sangye]

I got this email newsletter from JHU today about osteopenia. I thought it might be interesting to members who are learning about bone density.
What Does “Osteopenia” Really Mean?: Johns Hopkins Health Alerts

Here's the text:

Osteopenia is a word coined by the World Health Organization (WHO) that doesn't mean anything in particular other than a specific category of T-scores, corresponding to a bone density value between 1 and 2.5 standard deviations below the average value at peak bone mass.

WHO originally set up T-scores as an epidemiologic tool to measure rates of low bone density across countries. T-scores were never intended to be used to label individual patients with some kind of diagnosis.

Another important caveat is that the data being reviewed at the time by WHO experts was all collected from postmenopausal Caucasian women. The WHO researchers looked at this data set, looked at the relationship between T-scores and fractures and said, "Well, what cut point should we use to define osteoporosis?" They picked -2.5 because about a third of postmenopausal women will have a T-score below -2.5, and the lifetime risk of fracture for a 50-year-old Caucasian woman is around 39 percent.

Their thinking went this way: "If we pick -2.5, this gives us a prevalence of osteoporosis that is approximately equal to the lifetime risk of fracture for a woman at the time of menopause." This seemed like a rational cut point to examine rates of osteoporosis across countries. Then the researchers decided to devise a middle category of bone density to avoid having simply "normal" and "osteoporosis" categories. So, they decided to make a middle category of T-scores between -1 and -2.5 and labeled this category "osteopenia."

Many osteoporosis experts would like to see the term osteopenia just fade away because it is confusing to both patients and health care professionals. All it means is that a person’s T-score is between -1.0 and -2.5. We'd like to see "osteopenia" replaced with a term like "low bone density." That's because we want people to focus on their 10-year risk of fracture and not worry about their specific bone-density category as defined by T-score.

[Jack]

An interesting article.

I think that my own T score fell off the bottom of the scale, so I'm not sure how I manage to stay in one piece. And I know for a fact that there are plenty who are much worse than me.

[elephant]

I have oestoepenia, but not taking anything for it. I did it about 18 months ago. Thank goodness I stopped, because the denist was concerned when he had to pull me tooth out. He said that I might have slow healing, but it is a wait and see.

[pberggren1]

I am going to take my last Alendronate tablet this week. I have not told my doc that I am quitting it. In fact, I may never tell him. There are a couple of things we don't see eye to eye on and this is one of them. If he asks in the future I will tell him the truth. I know that he will respect my decission but will give me a lecture and bring up articles on the computer to back him up for 30 minutes or so. He is a good doc with good intentions.

[Jack]

I can understand anyone wanting to quit this drug, but think you should come clean with your doctors about your decision. I put off starting to take it myself for a long time, but it is now a case of the least worse option for me.

[Sangye]

I agree with Jack that it's best to be truthful with your doc. If he thinks you're still taking it he might be making other decisions based on that. And in the same way that you don't want your doctor changing something without telling you, it's best to be honest with him about what you're doing. It's a relationship like any other relationship, which means it functions best when there's trust.

You could tell him you understand his viewpoint and the risks, but you've also made this decision based on your own investigation. I don't follow all the recommendations of my various doctors but I do let them know what I'm doing/ not doing. And there are some recommendations that I'm not willing to discuss, like vaccines. I'm as educated as they are in that area--moreso, actually-- and I don't need to hear the lectures.

[pberggren1]

Thanks Jack and Sangye. I will tell my doc tomorrow.

[drz]

Thanks Jack and Sangye. I will tell my doc tomorrow.

That is good since the insert says there are some possible interactions with other drugs that might affect his decision on what other drugs he prescribes for you or the dosages.

I hate taking it too but asked my doctor about stopping it and he reminded me about what I learned in the classes on preventing falls and the leading cause of death for older people. I have also seen the suffering of people who had their spine collapse from osteoporosis and that does not appeal to me either so if it helps avoid that I will continue with it I guess.