What is Osteopenia
Osteopenia is a loss of bone mineral density that occurs as the bones weaken due to fewer minerals and a disrupted structure. It usually does not cause noticeable symptoms but, over time, can progress into osteoporosis with further weakening of the bones and increased fracture risk. A functional medicine approach to osteopenia and bone health takes an individualized systems-wide look at identifying and addressing lifestyle and other factors that contribute to inflammation and an imbalance between bone strength and breakdown.
Osteopenia is common, impacting around 34 million Americans, especially those over age 50, women after menopause, and those with poor nutrition, although anyone can be affected, including younger people and men. Fortunately, a healthy lifestyle can restore and promote optimal bone health throughout the lifespan.
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What Causes Osteopenia
Your bones are living tissues that are metabolically active and continuously remodeled throughout your life. Within bones are a matrix of bone cells, collagen, minerals (mainly calcium and phosphorus), hormones, growth factors, and immune cells.
There are three main types of cells that help to remodel the skeleton.
- Osteocytes help to keep bone tissue alive and healthy.
- Osteoblasts help to build bones.
- Osteoclasts are formed by monocytes (immune cells) in the bone marrow and instruct the body on how to break down bone and release the stored minerals (like calcium and phosphorous) into the bloodstream.
Bones remain healthy and strong when these cells maintain balanced and coordinated signaling. But if these signaling cells become uncoordinated due to inflammation or other dysfunction throughout the body, osteoclast production can outpace osteoblast production, which leads to the bone being broken down faster than it is being built. The bone density becomes weaker, leading to osteopenia and, eventually, osteoporosis.
In addition to bone density and strength, adequate and balanced muscle strength is also needed to support the skeletal system and prevent injury.
While bone density gradually declines throughout the lifespan, some things can accelerate this decreased bone density and lead to osteopenia. These include:
- An imbalanced diet, especially one lacking vitamin D, vitamin K, phosphorus, and calcium
- Hyperthyroidism
- Medications like steroids (i.e., prednisone), protein pump inhibitors (PPIs), and other acid-suppressing medications
- Hormonal changes during menopause
- Surgery or conditions which impact the gastrointestinal system’s ability to absorb nutrients
- Smoking, alcohol, and caffeine intake
- Not getting adequate weight-bearing exercise
- Chronic stress
Low Nutrients
Many nutrients work in conjunction to maintain healthy bone density. In addition to calcium and phosphorus, which make up much of bone’s structure, vitamin D increases calcium absorption and utilization. Vitamin K is also needed to make osteocalcin, a molecule that binds calcium within the bone.
Stress
When the body is under stress, it activates the immune system and contributes to systemic inflammation. To cope with this stress and resulting inflammation, minerals like calcium are needed, which are often taken from the bones. Sustained levels of the stress hormone cortisol further signal the kidneys to lose more calcium in the urine, leaving fewer minerals to rebuild bone strength.
Low Stomach Acid
Ongoing stress and medications like PPIs also reduce stomach acid, which impairs the body’s ability to break down and digest essential minerals, proteins, and other nutrients needed to maintain bone strength.
Inflammation
Many causes of systemic inflammation can lead to dysregulated bone strength and remodeling over time. For example, food sensitivities and allergies can trigger inflammation in the gut and activate the immune system. This causes impaired digestion and absorption of nutrients, imbalances in the microbiome, a leaky gut lining, and breakdown of bone.
Toxins
Similarly, exposure to environmental toxins such as heavy metals like lead, cadmium, and mercury, chemicals, smoking, alcohol, and endocrine disruptors in pesticides, personal care, or cleaning products can burden the body with inflammation and dysregulate the immune system and bone remodeling.
Estrogen Imbalance
Estrogen is a key regulator of bone metabolism. As estrogen levels decline nearing menopause, there is an increase in bone resorption due to estrogen’s impact on osteocytes, osteoclasts, and osteoblasts.
Genetics
A combination of genetic factors involving the interaction of several genes and environmental factors can influence the risk of bone weakness leading to osteopenia and osteoporosis.
Osteopenia Signs & Symptoms
Osteopenia does not generally cause noticeable symptoms and is usually only detected through screening. Occasionally, osteopenia may lead to bone pain or weakness, sometimes due to low vitamin D levels.
Who’s at Risk for Osteopenia
Due to the physiological changes that often come with aging, osteoblastic activity naturally declines, while osteoclastic activity increases with age. In general, this is due to increased inflammation from various systemic causes like an imbalanced diet, dietary irritants like gluten, infections, toxin exposures, imbalanced gut microbiome, stress, and a lack of movement.
In addition, some natural factors increase the risk of osteopenia, including:
- Being Asian or Caucasian
- Being a woman, especially after menopause
- Having a family history of osteopenia or osteoporosis
- Having surgery to remove the ovaries
- Having hyperthyroidism
What’s The Difference Between Osteopenia And Osteoporosis?
Osteopenia refers to the early signs of bone mineral density loss. As the condition progresses and more bone density is lost, osteoporosis can develop with an increased risk of fracture and complications.
What Can I Do To Prevent Bone Loss?
In addition to uncovering and addressing underlying root causes of inflammation and decreased bone density, some general steps can be taken to reduce the risk of osteopenia.
- Avoid smoking
- Limit alcohol use
- Decrease intake of carbonated and caffeinated beverages
- Get regular weight-bearing exercise
- Maintain a healthy weight
- Balance your diet with plenty of whole food sources of minerals like calcium, vitamin D, and vitamin K and avoid processed sugars, processed carbohydrates, inflammatory fats, and other additives
Conventional Labs to Diagnose Osteopenia
DEXA
Bone density is measured with dual-energy X-ray absorptiometry or a DEXA scan. A DEXA scan is an imaging test that uses X-rays to determine the density and strength of bones throughout the body. It provides a measurement called a T-score that helps to classify the strength of bones and diagnose osteopenia and osteoporosis.
- +1 to –1 represents a normal bone density
- –1 to –2.5 represents osteopenia
- –2.5 or lower signifies osteoporosis
The U.S. Preventive Services Task Force recommends that all women over 65 should have a bone density test in addition to others at high risk for bone changes.
FRAX
The Fracture Risk Assessment Tool (FRAX) is also used to evaluate the fracture risk in weakened bone mineral density. This tool considers age, gender, race, bone mineral density scores, and other relevant medical history to help predict a person's 10-year risk of having a fracture.
Functional Medicine Labs to Test for Root Cause of Osteopenia
Basic Labs + Inflammatory Markers
Laboratory testing can assess the general state of nutrition, the health of blood cells, and immune function. These include complete blood count (CBC) and comprehensive metabolic profile (CMP) in addition to inflammation markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to assess inflammation levels throughout the body, which is a major driver of osteopenia.
Some bone resorption markers can be measured in the urine or blood, which can give insights into the process by which osteoclasts break down bone tissue. N-telopeptide and C-telopeptide can be measured in the urine to track bone resorption over time. Since they fluctuate throughout the day, it is essential to measure them at the same time each day of sampling.
Hormones
Several hormones influence optimal bone density as they direct osteoblast and osteoclast activity and the mineralization of bones.
Saliva, serum, and urine tests are available to assess the balance of estrogens and other sex hormones. The DUTCH Complete dried urine test, Complete Hormones Panel, and Estrogen Elite Profile measure various hormones to assess hormone balance and metabolism that can impact bone health.
Parathyroid hormone (PTH) helps to regulate calcium and is another hormone that impacts bone strength.
Vitamin D and K
Since vitamin D and K2 play important roles in bone density, levels can be measured in the blood to optimize them.
Microbiome and gut health
To assess the state of the microbiome, which is known to play a vital role in the development of systemic inflammation that can impact bone turnover, a Comprehensive Stool Test can be used to measure amounts of healthy and unbalanced gut bacteria (dysbiosis), inflammatory markers, leaky gut, parasites, and yeast.
Food sensitivities can increase intestinal permeability, inflammation, and dysregulated bone turnover. Foods to which an individual is sensitive can be identified with ELISA testing.
Toxic Burden
Organic acid testing can provide a comprehensive look at metabolic function, toxic burden, and amino acid balance to assess the role these are playing in bone health.
Osteopenia Prevention
Maintaining strong bones and restoring bone mineral density requires an individualized multifactorial approach that addresses inflammation, dietary, lifestyle, and environmental factors.
Anti-inflammatory Diet
Since inflammation is a driver of bone loss, diet is a powerful way to help restore balance and maintain adequate nutrients to build bone strength. A whole foods-focused diet that emphasizes fresh produce, healthy fats, and protein and minimizes processed sugars, inflammatory fats like vegetable oils, and additives is recommended.
Omega-3 fats
Omega 3 fatty acids from fatty fish like salmon, walnuts, or fish oil supplements have been shown to augment bone mineralization and help prevent bone loss and osteopenia.
Protein
In addition to adequate minerals like calcium and vitamins D and K, dietary protein is needed for strong bones. Protein makes up roughly 50% of the volume of bones and about one-third of their mass, so a healthy balanced diet, including personalized protein sources, is critical for long-term bone health.
Calcium
While calcium is not the only essential nutrient for bone health, it is one factor that builds bone mineral density. It is best to obtain adequate calcium intake from foods like green leafy vegetables, tofu, and nuts versus supplementation to reduce the risk of kidney stones and cardiovascular complications. Calcium intake should also be balanced with vitamin D and K intake and adjusted based on laboratory monitoring.
Vitamins D and K
Vitamin D3 helps to improve bone mineralization by increasing calcium absorption in the intestines and decreasing bone turnover. Optimize vitamin D by adequate dietary intake through sources like salmon, mushrooms, cod liver oil, sardines, or liver, natural sunlight, and supplementation when needed.
Vitamin K2 is also crucial for balanced bone mineralization. Foods rich in vitamin K include fermented soybeans in natto, eel, beef liver, sauerkraut, and egg yolks. K2 is created by the bacteria in the gut microbiome, so maintaining a balanced microbiome is key for bone health and overall balanced inflammation.
Magnesium
Around half of the magnesium in the body is stored in the bones, which supports the production of hydroxyapatite and bone marrow stromal cells as well as 1,25(OH)2D vitamin synthesis. Magnesium deficiency can lead to a decline in osteoblast activity with altered bone microarchitecture, so maintaining proper levels is important for strong bones. To ensure you are getting adequate magnesium intake, load your plates up with green leafy vegetables, legumes, nuts, seeds, and whole grains.
Boron
Boron is another mineral that is needed for stimulating bone growth and metabolism. It activates 1,25(OH)2D3 production and increases bone mineralization. Boron is found naturally in leafy greens like kale and spinach, as well as prunes, raisins, nuts, and grains.
In addition, nutrients like copper, iron, manganese, selenium, and zinc are needed to balance bone strength and metabolism.
Berberine
Research suggests that berberine can help to lower osteoclast activity and boost osteoblast activity.
Exercise
Balanced exercise can help boost bone health and maintain muscle strength to prevent injury and fractures. Weight-bearing activities like walking, jogging, yoga, and tai chi, as well as strength and resistance training, can help maintain healthy bones.
Stress Management
Finding a meaningful practice for managing stress is vital for a balanced lifestyle and bone health in the long term.
Summary
Osteopenia occurs when bones lose mineral density due to imbalances in bone metabolism and turnover. Over time, this weakening of the bones can progress into osteoporosis with an increased risk of fractures and other complications.
Bone strength is determined by systemic factors like overall inflammation and nutrient status in the body. Therefore, a functional medicine approach to preventing osteopenia looks at factors like gut health and environmental exposures that contribute to systemic inflammation, stomach acid, digestive health, and dietary quality that provides the building blocks for healthy bones.
Functional medicine testing can help measure levels of inflammation as well as bone-supporting nutrients like vitamins D and K2 to target underlying causes. Fortunately, lifestyle approaches like incorporating weight-bearing exercise, eating a balanced, nutrient-rich anti-inflammatory diet, and managing stress can help ensure healthy bones throughout life.
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