By Judy Foreman
QUESTION: I am 60 years old and just had a bone density test. It showed I have osteopenia and that I have a "T-score" of minus 1.59 in the spine and a "Z-score" of minus 0.4. What does all this mean? Should I be treated?
ANSWER: Osteopenia is not a disease but a warning sign that you have lower than normal bone density, which can raise the risk of fractures somewhat and may develop over time into osteoporosis, says Dr. Michael F. Holick, director of the bone health clinic at Boston University Medical Center.
Osteoporosis is more serious bone loss and is even more likely to lead to fractures. According to the National Osteoporosis Foundation, osteoporosis affects 10 million Americans, most of them older women; an additional 34 million people are at risk of osteoporosis because they already have low bone density, or osteopenia.
The T-score is a comparison of your bone density with the peak bone density of a person of the same sex and race at age 30. A normal T-score is arbitrarily set at zero, plus or minus one standard deviation. In other words, any T-score between minus 1 and above is fine. Your score of minus 1.59 is slightly outside this range. To meet the definition of genuine osteoporosis, your T-score would have to be minus 2.5 The Z-score is not very useful. It's a measure of your bone density compared to other people of the same sex and age. Since you are 60, your Z score of minus 0.4 means that you have slightly lower bone density than other women your age.
In general, whether a person needs to be treated for osteopenia depends on how severe it is and other factors such as whether he or she has had broken bones or taken steroid drugs (which can harm bone tissue). If you need prescription drugs, the choices are usually those used for osteoporosis.
These include Fosamax, Actonel, estrogens such as Premarin, estrogen-progestin combinations such as FemHrt or Prempro, or a "designer" estrogen called Evista. (Another medication called Forteo, parathyroid hormone (1-34), is only used for outright osteoporosis and even then, only in people who have not responded to other drugs.) Even if your doctor says you don't need prescription drugs, you should take at least 1,200 milligrams of calcium a day (like TUMS, Caltrate, CitriCal or OsCal) and at least 400 to 800 International Units of vitamin D, says Holick. Weight-bearing exercise is critical, too -- you should walk at least three to five miles a week. You should also get a repeat bone density test in a couple of years.
For more information, go to the National Osteoporosis Foundation.
Judy Foreman is Lecturer on Medicine at Harvard Medical School and an affiliated scholar at the Women's Studies Research Center at Brandeis University.
© 2004, Judy Foreman. Distributed by Tribune Media Services International.
