What Is Osteopenia?

Your bones naturally get thinner as you age. Osteopenia is the medical term for bones that are weaker than normal but not yet at the level of osteoporosis. As bones thin, they become more likely to break (fracture). This is a problem because breaking a bone can have serious consequences on health and quality of life. 

Knowing if you have osteopenia can be hard because it doesn’t have symptoms. That’s why  screening for osteopenia is so important. It allows you to take steps to improve bone health and prevent osteoporosis before it happens. Read on to find out more. 

Who’s most at risk of developing osteopenia?

There are some risk factors for developing osteopenia that are out of your control. But there are  some that you can control. There are also some medical conditions that increase your risk of osteopenia. We’ll review all of these here.

Risk factors you can’t control:

• Age: Older women are at the highest risk of being diagnosed with osteopenia.

• Hormones: Around the time of menopause (specifically the years before and after a woman’s last menstrual period), loss of bone strength occurs due to lower estrogen levels. 

• Genetics: Your risk of developing thin bones as you age increases if one of your parents had thin bones or a fracture due to thin bones.

Risk factors you can control:

• Smoking and drinking: Smoking cigarettes and drinking excess alcohol increase the risk of developing osteopenia. 

• Steroid use: Taking oral steroids reduces bone strength. If you need to be on steroids, it's important to take the lowest effective dose for the shortest time possible to minimize this risk. 

• Other medications: Some other common drugs, like proton pump inhibitors and antidepressants, may lead to reduced bone strength, too.

Medical conditions that increase your risk of osteopenia:

• Hormonal/endocrine: overactive thyroid, low sex hormones, diabetes, low growth hormone levels

• Gut/gastrointestinal: inflammatory bowel disease, anorexia nervosa, history of gastric bypass

• Kidney: chronic kidney disease and other rare forms of kidney disease

• Blood: multiple myeloma and some forms of thalassemia

• Autoimmune/inflammatory: rheumatoid arthritis, lupus, multiple sclerosis

Who should get tested for osteopenia?

Since osteopenia doesn’t cause any symptoms, the only way to know you have it is to get screened for it. But not everyone needs bone health screening. 

Official screening guidelines specify different recommendations for “women” and “men,” but there aren’t specifications for transgender people yet.  

The current United States Preventive Services Task Force (USPSTF) guidelines recommend baseline bone measurement testing for:

• All women 65 years of age or older

• Postmenopausal women younger than 65 years old with risk factors

In clinical practice, many healthcare providers repeat testing every 2 to 10 years in the absence of clear recommendations from the USPSTF.  How often usually depends on the results of the initial scan. Medicare will typically only pay for bone measurement testing once every 2 years.

Other societies have different recommendations for bone screening. The International Society for Clinical Densitometry (ISCD), the National Osteoporosis Foundation (NOF), and the Endocrine Society also recommend screening all men 70 years of age and older, and men aged 50 to 70 with risk factors. 

And the ISCD guidelines even recommend screening women premenopause if they have risk factors.

Leaders in transgender healthcare recommend bone screening for: 

• All people starting at age 65

• Some people aged 50 to 64 with risk factors

• Any transgender person of any age who hasn’t had hormone replacement therapy for 5 years of more after a gonadectomy

How is osteopenia diagnosed?

The most common bone measurement testing used in the U.S. is a dual-energy X-ray absorptiometry (DEXA) scan. This test measures how well specific bones absorb low-dose X-ray beams. The measurements are usually taken in the hips and the spine. Healthcare providers use these measurements to calculate how dense or how thin those bones are. A DEXA scan is a safe, quick, and painless test. A specialist trained in reading scans (a radiologist) interprets the measurements after the scan is completed.

Understanding your DEXA scores

After the DEXA scan, you and your healthcare provider receive a DEXA report with values called “T-scores.” Typically you’ll see T-scores measured on areas such as the lower back, hip, and the top of the thigh bone. Your lowest T-score determines your diagnosis.

How do you treat osteopenia?

Treating osteopenia means preventing further thinning of the bones. It can also mean slowing the rate at which your bones lose strength. Remember: Some bone thinning is normal with age. 

The most effective way to slow bone loss is to make sure you practice healthy dietary and exercise habits: 

• Eat 1,200 mg of elemental calcium daily. You absorb and use calcium better when you eat it in food. So it’s preferable to get this from your food rather than a pill.

• Do weight-bearing exercise daily for at least 30 minutes. Examples of weight-bearing exercises include walking, dancing, and tennis. 

In some cases, treating osteopenia may also involve stopping or changing medications you take for another health condition. It’s important to review your current medication and supplement lists with your healthcare provider. And ask if any of the medications you take may be negatively impacting your bone strength. If that’s the case, check if it might be possible to discontinue them.

Vitamin D supplements are an important component of optimizing bone strength. This is especially true if you live in a climate with limited sun exposure. If you have certain risk factors, you can ask your healthcare provider to check your vitamin D levels. Then, your provider may recommend a high-dose prescription vitamin D (like vitamin D2 50,000 IU weekly). All adults with increased fracture risk (including everyone over 70 years old) should make sure that they’re getting at least 800 IU of vitamin D3 daily.

Preventing osteopenia

Here’s the good news: There are ways to maximize your bone density and strength during your life. One of the most important ways to do this is maximizing your peak bone mass. Peak bone mass is the time in your life when your bones are the strongest. This usually happens when you’re in your 30s. So being physically active and having good nutrition as a child and young adult can set you up for having healthier bones as you get older.  

How is osteopenia different from osteoporosis?

Osteopenia is thinning of the bones that doesn’t yet meet the threshold to diagnose osteoporosis. You can almost think of it as “pre-osteoporosis.” Both osteopenia and osteoporosis are diagnosed the same way — through a DEXA scan. In some cases, a DEXA scan will indicate that you don’t have osteoporosis. But then you may get an osteoporosis diagnosis due to a “fragility fracture.” This is when a thin bone breaks after a very low-impact injury. Or it may happen with no injury at all. 

The main difference between osteopenia and osteoporosis boils down to treatment. Healthcare providers recommend prescription medications — in addition to lifestyle changes — for most people diagnosed with osteoporosis. These treatments aim to reduce the risk of fracture. But there are no prescription medications routinely recommended for people with osteopenia.

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Written by:

Meg Burke, MD

Meg Burke, MD, is a practicing primary care geriatrician in the Denver, Colorado area. She is board-certified in internal medicine and geriatric medicine, and received her undergraduate and medical degrees from Georgetown University in Washington, D.C. After graduating from medical school, Dr. Burke completed her internal medicine residency at Johns Hopkins Bayview Medical Center and her two years of subspecialty training in geriatric medicine at the Johns Hopkins Hospital in Baltimore, Maryland.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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