Osteopenia: less severe but more common than osteoporosis

You’ve just got word from your healthcare provider that you’ve got osteopenia after a bone scan. The first thing on your mind—what’s osteopenia? And the second—how do I deal with it?

Let’s take a deep dive into this sibling of osteoporosis, and what it might mean for you.

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Don’t sweat that you might not know much about osteopenia. It’s not nearly as well known as osteoporosis and much less in the news.

In fact, Google Trends suggests that you’re four times more likely to search for osteoporosis than osteopenia. This is despite the fact that you’re five times more likely to have osteopenia than osteoporosis if you’re a woman and 15 times more likely if you’re a man (Looker, 2010). 

So what exactly is osteopenia? Osteopenia is just a fancy term for low bone mass. The World Health Organization’s (WHO) definition of osteopenia is a bone density T score of -1 to -2.5. This bone density score comes from scanning bones in your leg and spine with a special X-ray called a DEXA or DXA scan that determines how dense they are.

These measurements are then compared to a healthy 30-year-old of the same age and race as you. Zero means your bones are just as dense. The lower (more negative) your T score is, the less bone mass you’ve got. If you’ve got a T score of less than -2.5, you’re diagnosed with osteoporosis instead.

The best way to think about it is, with osteoporosis being at one end of the spectrum and healthy bone being at the other, you’re in the middle of those two categories. This means that you’re at an increased risk of bone fracture compared with a healthy adult, but not as prone to fractures as someone with osteoporosis. 

Most people with osteopenia don’t know they have it—having it won’t cause any pain or other significant symptoms. It’s a “silent disease,” just like osteoporosis.

You’re at an increased risk of fractures, but almost by definition, won’t have symptoms until you reach osteoporosis. This is because one of the diagnostic criteria for osteoporosis is having a fragility fracture.

To make things clear, let’s use the example of a man with osteopenia. If he suffers a wrist fracture, for instance, he automatically gets diagnosed with osteoporosis. Many more people have a T score that’s in the osteopenia range than the osteoporosis range. Because of this, most of the people who get fractures in old age have an osteopenia-level bone density (Cranney, 2007). 

We have two types of bone-changing cells that live in our bones. One type, called osteoblasts, builds new bone, while the other, osteoclasts, breaks bone down. We need both cell types to work in harmony to fix damage to our bones and to grow and mold them in response to the way we live our lives.

When we’re young, the osteoblasts are more active than the osteoclasts, which increases the density of our bones and makes them strong. We reach peak bone mineral density (BMD) in our twenties, after which the osteoclasts slowly become more active in comparison to the osteoblasts.

This means that our bone density declines, year by year, as we age. When the bones lose enough BMD, you fall into the osteopenia range and are at a higher risk of fracture. As the process continues, you might even go into the osteoporosis range of bone density, and your fracture risk goes up even higher.

So what are the risk factors for low bone density? For starters, there are certain risk factors you can’t change. Women, older people, smaller and thinner people, and people with a family history of osteoporosis are all at higher risk of having low bone density (Lee, 2013).

If you identify as black, however, this may be a protective factor. There are other risk factors that you can change: smoking, alcohol abuse, and chronic glucocorticoid steroid medication use all increase the risk of osteopenia (Briot, 2015). 

To prevent osteopenia and osteoporosis, the best approach is two-pronged: build strong bones when you’re young and prevent bone loss as you age. To build more bone when we’re in our youth, it’s important to get enough calcium and vitamin D in your diet (Huncharek, 2008).

This might mean eating and drinking fortified dairy products, which have good amounts of both nutrients. High impact exercise, with activities like jumping, is also important. As we age, we need to continue eating a well-balanced diet with sufficient calcium and vitamin D to maintain good bone health.

We need to avoid smoking and excessive drinking, both of which will cause loss of bone. And, of course, we need to continue exercising and getting enough physical activity.

Osteopenia is usually diagnosed via a bone mineral density scan called a DEXA scan. This bone density test uses X-ray beams to test your bones, typically at your lower spine and your femur, the big bone in your upper leg.

Your healthcare provider might ask you to get a DEXA scan as a screening test, especially if you’re an older woman or have risk factors for developing osteopenia or osteoporosis. The National Osteoporosis Foundation (NOF) recommends that you get a DEXA scan if you are: 

• A woman aged 65 or older

• A postmenopausal woman with risk factors for fracture

• A man aged 70 or older

• A man aged 50-69 with risk factors for fracture

• A person who has s broken a bone after age 50

It’s important to know about your bone mineral density because you can make lifestyle changes to improve it if it’s low.

Your healthcare provider might ask you to start a weight-bearing exercise program and take calcium or vitamin D supplements, especially if your blood levels of those important nutrients are lower than normal. Usually, osteopenia isn’t treated with medications.

However, if you are at high risk for bone breaks, your healthcare provider might decide to prescribe medications to increase your bone density, such as bisphosphonates. These medications are typically reserved for people with osteoporosis.

If you’re concerned about your bone strength or risk of developing a bone disease, talk to your healthcare provider. They’ll be able to evaluate your risk factors and determine which tests, if any, are right for you. Remember to always let your healthcare provider know about any supplements you decide to take.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

November 15, 2019

Written by

Jefferson Chen, MD

Fact checked by

Chimene Richa, MD

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About the medical reviewer

Chimene Richa, MD

Dr. Richa is a board-certified Ophthalmologist and medical writer for Ro.