So the Charlotte woman was surprised two years ago to be diagnosed with osteopenia. It's considered a precursor to osteoporosis, a condition that can make bones so brittle a minor fall may cause a broken hip.

"I thought 'It can't be,'" Gaspari said, "because I'm outside a lot, exercise and lift weights."

She's among an estimated 34 million Americans -- 80 percent of them women -- who have osteopenia (os-tee-oh-PEE-nee-a), which means their bones contain less calcium and thus have low density.

The condition was identified in the mid-1990s when the bone density scan became the standard for diagnosing osteoporosis.

Doctors have been using the same drugs that fight osteoporosis as treatment for osteopenia.

But there's a wide range of opinions on which patients should be medicated and which should make simple lifestyle changes like getting more exercise and calcium.

Osteopenia was never meant to be a clinical diagnosis, said Dr. Michael McClung, director of the Oregon Osteoporosis Center. "Healthy women are being given this term, which sounds like a serious medical problem."

A new formula due out later this year from the World Health Organization is expected to help create a more uniform standard of treatment.

That will be welcome news for McClung and a growing number of experts who believe some doctors have been too aggressive in medicating younger women to prevent fractures from occurring as much as 30 years down the road.

Low Risk of Fracture
Osteopenia usually has no symptoms. It's diagnosed by a low-dose X-ray called a bone density scan. In general, the lower your score on the scan, the weaker your bones. At one end of the scale are normal bone densities. At the other end are densities low enough to increase fracture risk.

The middle ground was dubbed "osteopenia," which simply means low bone density. Some who have this condition are healthy women in their 30s or 40s whose risk of fracture is extremely low.

The scale was originally developed for post-menopausal women, said McClung, "because that's where we know what the relationship is between bone density and fracture risk."

But he said many doctors are also diagnosing osteopenia in pre-menopausal women, even though the scale wasn't designed for that.

Warned of Drug's Side Effects
"Once you have osteoporosis, you need medication," said Charlotte rheumatologist Dr. Robert Kipnis. "Osteopenia is more of a gray area."

Gaspari's doctor prescribed the osteoporosis drug Fosamax based on her low score on the bone density scan and family history of osteoporosis. Her mother and grandmother have osteoporosis, and her mother has broken a hip.

She took the drug for about a year then stopped when her oral surgeon cautioned her about its side effects. In rare cases patients have poor healing of the jaw bone after oral surgery. The most common side effects are heartburn and abdominal pain, but some patients report severe bone and muscle pain.

Density Can Still Be Normal
Having osteopenia, said McClung, doesn't automatically mean bone loss has occurred. That's because the condition includes people whose bone density is low but still in the normal range. For women with mild osteopenia, McClung and Kipnis said a regimen of calcium, vitamin D, exercise, low alcohol consumption and stopping smoking can be a reasonable alternative to drug therapy.

The real danger of low bone density is the risk of fracture. And fracture risk increases with age.

Most people with osteopenia are at low risk for fracture, McClung said.

Studies show bisphosphonate drugs such as Fosamax, Actonel and Boniva reduce fracture risk in osteoporosis patients. But there is little evidence that they reduce the risk in people with osteopenia, according to a recent article in the New England Journal of Medicine.

When the World Health Organization releases its new formula this year, it will combine bone density with a number of other risk factors to help create more standardized guidelines for osteopenia treatment.

"This will make it clearer and more straightforward about what to do," said McClung.

As for Gaspari, she's increased her exercise and is taking more calcium and vitamin D. She's also due for a physical soon and will talk with her doctor about other options for treating her osteopenia.

Source: The Charlotte Observer, N.C. Distributed by McClatchy-Tribune Information Services. Powered by YellowBrix.

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