Q: My daughter has been told she has osteopenia. I've never heard of it: what is it and how is is treated?
Osteopenia is a state that sits between normal bone density and the low densities associated with osteoporosis. In the latter condition bones are fragile and break easily but the significance of osteopenia is more contentious. Some who have it never develop osteoporosis but the term is used to identify a group of people who may be at increased risk of the disease. It can only be diagnosed with a bone density scan.
Most patients do not require treatment but the condition needs to be monitored over time, ideally by means of serial scans, as bone density may continue to drop. Drug treatment may be considered If the individual has extra risk factors for osteoporosis; these include being female, a small frame, high alcohol intake, smoking, early menopause, previous fracture, being inactive and a history of steroid use or anorexia. This is one of the few conditions where a higher body weight is protective!
Some of these risk factors can be affected by lifestyle changes so your daughter needs to check if any of those apply to her and if so, take appropriate steps. She also needs to make sure her calcium and vitamin D intake is adequate.
Q: I woke up one morning three weeks ago with a sharp pain along the length of my left lower rib. There's a slight swelling and the pain has eased, but still hurts. What could have caused it?
Since this pain is very localised and precise in its location it’s likely to be originating in the structures of the chest wall; that means from the lung surface outwards, including the ribs, the muscles between and overlying the ribs and the structures of the skin surface. Deeper structures such as the heart or lungs are less likely to give rise to a localised pain like this. Occasionally pain can radiate from other sites and problems in the spine can result in pain along the lines of the ribs. The first few days of shingles can give rise to localised pain but a rash eventually makes the diagnosis.
Overall this pain is most likely to originate from bone or muscle in the chest wall and probably arises from an injury. You may well not remember whatever caused it; the pain is sometimes at its worst a few days later. Injury to ribs can also occur with violent coughing, poor posture when sitting or sleeping, and posture changes with age. If the pain doesn’t continue to subside, you should see your doctor who can take a detailed history and examine you.