The Joint Effort Podcast

Understanding Osteopenia vs Osteoporosis For Real-Life Prevention

• Dr. Noelle DiGioia Guthrie & Tiffany Belculfine, PA • Episode 2

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How Does Osteopenia Differ From Osteoporosis?

Most people don’t realize their bones are losing strength until a fracture forces the issue. We dive into the real-world differences between osteopenia and osteoporosis, why both conditions stay silent for years, and how early screening can change the arc of your health. With our team’s combined clinical experience, we break down DEXA scans, T-scores, and the risk factors that matter—smoking, alcohol, family history, chronic steroid use, chemotherapy, low activity, and nutrition gaps—so you can make informed choices before a break happens.

We get practical about prevention. You’ll hear how weight-bearing exercise, resistance training, and balance work stimulate bone remodeling and cut fall risk, and how a food-first approach to calcium, vitamin D sufficiency, and enough protein supports stronger bones and muscles. We also address the quality-of-life realities: why fragility fractures disrupt independence, the surprising 33% mortality after hip fracture, and how focusing on everyday abilities—like getting off the floor or carrying groceries—protects the life you want to live.

We also tackle a big myth: having osteoporosis does not automatically rule out hip or knee replacement. Osteoarthritis can coexist with low bone density, and careful surgical planning plus coordinated medical care can still deliver excellent outcomes. In fact, moving better after surgery can help rebuild strength and function, supporting your bone health long term. If you’ve delayed screening or felt unsure about next steps, this conversation gives you a clear, step-by-step way forward—screen early, move with purpose, fuel wisely, and repeat.

If this helped you see bone health in a new light, follow the show, share it with someone who needs a nudge to schedule a DEXA scan, and leave a rating and review to help others find us.

To learn more about The Bone and Joint Center at Magee-Womens Hospital visit: https://www.pghbjc.com
Dr. Noelle DiGioia Guthrie
300 Halket St.
Pittsburgh, PA, 15213
412-683-7272

To learn more about The Wellness Center for Bone and Joint Health visit: https://www.boneandjointhealth.org
Tiffany Belculfine
300 Halket St., Suite 1601
Pittsburgh, PA, 15213
412-641-8594

SPEAKER_00:

Welcome to the Joint Effort Podcast, where mobility meets reality and your future self says thank you. Your hosts, Dr. Noel DeJoya Guthrie of the Bone and Joint Center at McGee Women's Hospital, and Tiffany Belkafai, Physician Assistant at the Wellness Center for Bone and Joint Health, serving adults across western Pennsylvania. If your knees sound like bubble wrap, your hips argue with putting on socks, or your side-eyeing stares, you're in the right place. From arthritis and osteoporosis to everyday aches, they'll break it down and build you back up with a personalized plan for real life. The show is informational and not a substitute for talking to the clinician. Now, let's get you moving. Here are Dr. Noelle and Tiffany.

SPEAKER_01:

Bone loss is not just one size fits all. Understanding the difference helps you take action before fractures happen. Welcome everyone. I'm Julie Schwenzer, your co-host and producer in the studio with Tiffany Belcofine, Physician Assistant at the Wellness Center for Bone and Joint Health, and Dr. Noelle Guthrie of the Bone and Joint Center at McGee's Women's Hospital. Thank you both so much for being here.

SPEAKER_02:

Yes, good morning. Thank you. Thanks for having us.

SPEAKER_01:

So, Tiffany, Dr. Noel, thank you so much for joining us. So let's start with the basics. How does osteopenia differ from osteoporosis?

SPEAKER_03:

So I think it's really important for people to know that both of these are in fact related. So they're both silent diseases that can happen over time as time goes on. Our bones are at their healthiest when we're in our 30s. And then unfortunately, we don't usually get a DEXA scan until many years later. And often people are surprised to find out that they have one of these conditions. Osteopenia is actually the precursor to osteoporosis. So you can have a bone density that is normal, you can have one that shows osteopenia, or you can show one that is at its most severe osteoporosis. Unfortunately, the risk factors for both of those are very similar. And we can see this happen not only in women, but also in men, which is a myth that we're trying to bust for people to let them know that it's important to pay attention and get themselves screened with that bone density test.

SPEAKER_01:

And that's a good point you made because I looked this up using AI tools and the a couple of the first, you know, descriptions they said of likely, you know, uh people that would suffer from this. They said you have to be a woman, a smoker. They just said straight up, just a woman that that gets increases your chance. So that was interesting that you pointed that out. And how do you diagnose it uh in the DEXA scan or are there symptoms?

SPEAKER_03:

So usually there are no symptoms of osteopenia or osteoporosis unless someone sustains a terrible fracture. Then in those cases, they may have pain before they had the fracture or after they had the fracture. But usually there are no symptoms, there are no signs. So it's really just about the education of knowing what the warning signs are, knowing what everyone's personal risk factors are. And you're right, women are more at risk for this, but men can also be affected. Being a smoker is another risk factor. A family history is something we don't ever want to ignore. And making sure that people are making good choices in moderation if they consume alcohol, that can be another factor. Also making sure that if they've had a history of something like chemotherapy, that they have been screened sooner so that those issues can be caught sooner. And then other things like chronic steroid use can be a factor for people to develop either one of the conditions, not getting enough physical activity, not having proper nutrition. Those are all many risk factors that we want to pay attention to. And it's usually diagnosed on a DEXA scan. So that is the bone mineral density test that is done to see what people's bone health is showing.

SPEAKER_01:

And can people make changes with how they're, you know, exercising, how they're eating, their habits, can they reverse or slow it down the possibility of osteopenia and then osteoporosis?

SPEAKER_03:

Yes. It is so important for people to realize that what they see on their DEXA scan or at their doctor's office is not the end-all be-all answer. My second grade teacher was a big fan of saying never rest until your good is better and your better is best. So if you get a good bone density score, that doesn't mean you're done forever. That doesn't mean you can ignore it. You have to keep doing positive habits and keeping your health in check to make sure it stays good. If you fall into the middle range, the osteopenia precursor range, we want to make sure that you are doing the lifestyle changes that you can to prevent that score from getting worse. And we can see that score even improve. And then even if people are diagnosed with the most severe form, the osteoporosis, with small lifestyle changes and in some cases medication, those people can also see their bone density scores improve. So it's not all or nothing, all is not lost.

SPEAKER_01:

There's plenty of things you can do on your own. And a last question for you both. You both are experts in this field. And we see so many warnings and PSAs about other health risk factors, especially the heart, you know, don't smoke, cut down in alcohol, and um other things is all about like the head and the heart. Why do you think that this area of the body is not addressed more in the media or by health service announcements like things like that?

SPEAKER_03:

I think really and truly it becomes a quality of life issue for people that they don't really necessarily realize what their bones and their joints are doing for them on a daily basis. And if that is taken away with a terrible fracture or something, you know, really life-altering, that can affect the way that they walk, that can affect the way that they move. And you're right, it doesn't really get the attention that some of the other health conditions get. And unfortunately, people are often not screened until much later in life when they're in their 60s. So we're trying to raise that awareness so that people know this is something they need to pay attention to so that they don't endure a fracture or something, you know, really life-changing that can really alter the course of their days.

SPEAKER_02:

I agree with Tiffany. I think there's been a big push in the last few years to make musculoskeletal health a forefront part of um health education. I uh within the orthopedic community, there's a saying called own the bone, um, meaning that, you know, we're the people who treat people, treat bones. So we should see a person, we should be the first person to screen them for osteopene or osteoporosis. And, you know, when we get that information, we can try to treat it, but we can also refer to an endocrinologist. Uh we have a great center here at McGee. It's a a midlightlife women's health center who helps us, you know, treat conditions of osteoporosis and osteopenia and also postmenopausal issues that other women have. So that's a great resource. Um, but like like Tiffany said, I mean, if you sustain a hip fracture, there's a 33% mortality rate after a hip fracture, which is huge. That's a you know, a third just because a hip fracture kind of sets you back, you know, you you can be treated quickly, but the rehab after that usually takes a long time. So, and most people don't know that if you're not within the orthopedic, you know, um, bone health community. But I think that getting that message out that that fragility fractures are a big deal, they can impact your life hugely. Um, and we can prevent these things by doing screening earlier on, being educated about what you can do to, you know, vitamins you can take, nutrition, and stuff like that. So um I think typically bones don't, you know, they won't kill you, but like a heart, you know, heart, lungs are brain, less stroke or a heart attack, but um, they can definitely impact your life adversely if they happen.

SPEAKER_01:

And I wanted to throw in another and last question for you, Dr. Noel. Is from the last podcast we learned that you know, a lot of your routine involves helping patients with hip and knee replacements. What about osteopenia and actually this question's for both of you and osteoporosis? Does the you know having those conditions lead to those issues? Because I know so many people with knee and hip replacements.

SPEAKER_02:

Yeah, I mean, I think those are so osteoarthritis and osteoporosis penia, they can coexist. Um, they don't necessarily like osteopenia and osteoporosis don't lead to osteoarthritis, if that makes sense. And I know we'll talk a little bit more in another episode more about osteoarthritis, but there are a lot of patients who have hip and knee replacements who have underlying osteoporosis or osteopenia that um, you know, we see intraoperatively, we can essentially look at the bones and look at the quality of them. We notice it on the x-rays we get in the office. Um, so it's important for us, like I said, as the first line providers and those things to recognize that and you know help treat patients or help refer them to um, you know, physicians who are special. And I think particularly with Tiffany's, you know, with the wellness center, which is kind of our non-operative side of orthopedic, she's been doing an awesome job with talking patients through it, educating them, referring them to patients, treating them. Wow, you also must be like a pain coach, Tiffany.

SPEAKER_03:

There's a lot to it, really and truly. And and that's I honestly that's a part people don't realize is that, you know, when something does happen, like Dr. Noel said, when something happens, what is your quality of life going to look like after that? You know, you may not be able to pick up your dog anymore, you may not be able to play with your grandkids, you may not be able to sit on the floor. All of these things are very important life skills that we want to make sure people know how to do and that they know how to protect themselves for. Because as humans, we like to practice the things that are easy, not the things that are hard. So we want to challenge our bones and keep ourselves healthy and have as much knowledge as we can so that the next time we get a DEXA scan, we get a better result.

SPEAKER_02:

And I think it's important to know that you you you can still have a near hip replacement, even though you have osteoporosis or osteopenia. It doesn't preclude you from that. In fact, it actually probably, you know, getting a hip and replacement allows you to be more active and it can improve your that condition. So I think that's important because I do have a lot of patients who come in and say, Oh, I have, you know, I have osteoporosis. Um, I'm being treated for it. Can I have surgery? And I think that's kind of a myth that should be debunked for sure.

SPEAKER_01:

Okay, well, thank you both. Um, great insights. I learned a lot, and we really appreciate what you're doing for everybody in this field. Thank you. Thank you. And we'll see you next time for more Bone and Joint Wisdom.

SPEAKER_00:

That's today's dose of strength, balance, and better movement from the Joint Effort Podcast. Ready for care that fits your life and gets you moving? To schedule an appointment with Dr. Noel for your surgical and injection needs, call 412-683-7272. Or visit PGHBJC.com. Or if you are looking for lifestyle changes that are non-surgical, contact Tiffany Belkefine. Call 412-641-8594 or visit boneandjointhealth.org. Healthy bones and happy joints make every day better. Until next time, keep moving, stay steady, and take care of yourself!