What Is Osteopenia?
Learn how this early sign of low bone mass is different than osteoporosis — and how to manage it.
While osteopenia and osteoporosis have similar names, and both relate to bone loss and weakness, they are not exactly the same.
If you have low bone mass (low bone mineral density) compared with the norm — but it’s not low enough to be considered osteoporosis — your doctor may tell you that you have osteopenia.
Like osteoporosis, osteopenia raises your risk of a bone fracture, because the more porous your bones are, the more likely they are to break. But because people with osteopenia have higher bone mineral density than those with osteoporosis, the risk of a fracture is lower for individuals with osteopenia.
Osteopenia increases your risk of developing osteoporosis and is considered a precursor to it.
But not everyone with osteopenia will go on to develop osteoporosis, and changes in diet and lifestyle may help to prevent crossing the line from osteopenia to osteoporosis.
Neither osteopenia, nor the early stages of osteoporosis, typically cause any symptoms. But if you have risk factors for osteoporosis, or you experience a bone fracture, your doctor may advise you to have a bone density scan.
How Bone Mineral Density Is Measured
Your doctor will most likely determine your bone mineral density with a noninvasive test called dual-energy X-ray absorptiometry (DXA or DEXA). This test uses X-rays to measure bone density in the hip, spine, and sometimes other bones.
For postmenopausal women and men age 50 years and older, DXA results are given in what’s called T-scores, according to the Bone Health & Osteoporosis Foundation. T-scores help to determine which category — osteopenia, osteoporosis, or normal — you fall into:
- A T-score of -1 or higher means you have normal bone density.
- A T-score of -1.1 to -2.4 means you have osteopenia.
- A T-score of -2.5 of lower indicates osteoporosis. (1)
The lower (or more negative) the T-score, the weaker your bones.
The lower the T-score, the weaker your bones.
In the United States, approximately 54 million people have low bone density that puts them at risk for osteoporosis. (2,3)
Like osteoporosis, osteopenia affects older white women in the greatest numbers. But anyone can develop osteopenia, including men. Consider this: About a third of white and Asian men over age 50 are affected, and osteopenia also affects 23 percent of Hispanic men and 19 percent of black men. (1)
Although people with osteoporosis have a much higher risk of bone fractures than those with osteopenia, the majority of osteoporotic bone fractures occur in people with T-scores in the osteopenic range.
This is because significantly more people have osteopenia than osteoporosis, according to a study. (4)
Causes and Risk Factors for Osteopenia
Your bone density peaks around age 30, then slowly begins to decline as your body breaks down old bone faster than it forms new bone.
Your bones will become weaker and thinner if too much calcium is withdrawn from them, leading to osteopenia or osteoporosis.
Some bone loss with aging is natural and expected, but numerous factors can affect the rate of loss.
Factors known to increase the rate of bone loss, leading to osteopenia and osteoporosis, include the following.
Osteopenia risk factors you can't control include:
- Being female
- Going through early menopause
- Being at least 50 years old
- Having naturally small, thin bones
- Being Caucasian or Asian
- Having a family history of bone disease
Osteopenia risk factors you can control include:
- Drinking alcohol in excess
- Having dietary deficiencies in calcium and vitamin D
- Leading an inactive or sedentary lifestyle
Underlying conditions that raise your risk of osteopenia include:
- Having anorexia, rheumatoid arthritis, or another disease that can cause bone loss
- Having any malabsorptive diseases like celiac, or a recent bariatric surgery
- Having low levels of estrogen (in women) or low testosterone (in men)
- Having any malabsorptive diseases, such as celiac disease
- Recent bariatric surgery
Treatment for Osteopenia
Various lifestyle changes may help treat osteopenia, including:
- Getting recommended amounts of calcium and vitamin D in your diet
- Quitting smoking
- Limiting alcohol intake
- Exercising every day
- Following a nutrition-rich diet
Medication may also be an option for treating osteopenia, but many doctors are cautious about prescribing drugs for the condition, since your fracture risk with osteopenia is low, and medication may not reduce your risk by much. Potentially, it can expose you to possible drug side effects without a clear benefit that outweighs the risk. Additionally, more research is needed to assess the long-term benefits and risks of using medication to treat osteopenia. (1,4)
Your doctor may also suggest evaluating your FRAX score, which takes into account not just your T-score but also other variables that may lead to recommended medications even if you are still only in the osteopenic range.
If your T-score is under -2, your doctor may recommend lifestyle changes to improve your bone health.
If your T-score is close to -2.5 — or close to the osteoporosis range — it is possible your doctor may consider putting you on medication to keep your bones stronger and reduce the risk of fractures. Potential drugs include those used to treat osteoporosis:
- Bisphosphonates work by inhibiting bone resorption. These include alendronate (Fosamax), ibandronate (Boniva), and risedronate (Acetonel), which are administered orally and often weekly, and zoledronic acid (Reclast), which is an injection usually given every one to two years.
- Teriparatide (Forteo), a synthetic form of a hormone that stimulates bone formation
- Selective estrogen-receptor modulators such as raloxifene (Evista), which have positive estrogen-like effects on the bones
- Calcitonin (Miacalcin), which has been shown to increase bone mineral density
Even if you and your doctor decide to use medication, lifestyle measures, such as engaging in weight-bearing exercise and following a healthy diet, are still important.
Editorial Sources and Fact-Checking
- Osteopenia: When You Have Weak Bones, but Not Osteoporosis. Harvard Health Publishing. September 16, 2021.
- Osteoporosis. MedlinePlus.
- General Facts. Bone Health & Osteoporosis Foundation.
- Eriksen EF. Treatment of Osteopenia. Reviews in Endocrine & Metabolic Disorders. September 2012.
- Women’s Health Initiative. National Heart, Lung, and Blood Institute.
- Rosen HN. Postmenopausal Hormone Therapy in the Prevention and Treatment of Osteoporosis. UpToDate. October 21, 2021.
- Evaluation of Bone Health/Bone Density Testing. Bone Health & Osteoporosis Foundation.
- Welcome to FRAX. FRAX Fracture Risk Assessment Tool.