What Is Osteopenia? Risk Factors, Testing, and Treatment

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 lets you take steps to improve bone health and prevent osteoporosis before it happens. 

Who’s most at risk of developing osteopenia?

There are some risk factors for developing osteopenia that you can’t change. There are also some medical conditions that increase your risk of osteopenia. But there are some things you can do to lower your risk. 

How is osteopenia diagnosed?

The most common bone measurement testing in the U.S. is a dual-energy X-ray absorptiometry (DEXA) scan. This test measures how well specific bones — usually your hips and spine — absorb low-dose X-ray beams. 

Your healthcare team will use these measurements to calculate how dense your bones are. A DEXA scan is a safe, quick, and painless test. 

Does osteopenia have any symptoms?

No, osteopenia doesn’t usually cause symptoms. This is why it’s often called a “silent disease.” If osteopenia worsens into osteoporosis, a bone fracture can be the first sign that there’s a problem. This is why screening is so important. Many people don’t know they have osteopenia (or osteoporosis) until they get screened.

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. 

Your diet and exercise play a big part in slowing down bone loss: 

• Get plenty of calcium. After age 51, women should try to get 1,200 mg of calcium a day, while men should get 1,200 mg of calcium once they reach age 70. You absorb and use calcium better when you eat it in foods, including yogurt, milk, and fish. But supplements are also available. 

• Keep up your level of vitamin D. Vitamin D supports bone strength as it helps your body absorb the calcium you eat. You can get vitamin D from sunlight exposure and eating vitamin D-rich foods. If you don’t get enough from natural sources, vitamin D supplements can help you get the recommended daily amount of 400 IU to 1,200 IU of vitamin D.

• Eat a protein-rich diet. Protein makes it easier for your body to absorb calcium and helps with bone formation. Eating enough animal protein can support bone density.

• Do weight-bearing and strength-training exercises. Both weight-bearing and strength-training workouts can support bone density. Examples of weight-bearing exercises for osteoporosis include walking, dancing, and tennis. Strength training exercises use resistance, like your body weight, free weights, machines, or resistance bands.

Certain medications and supplements can affect your bone strength. This includes corticosteroids, selective serotonin reuptake inhibitors (SSRIs), and proton pump inhibitors (PPIs). If you’re at risk for osteopenia, make sure to review your medication and supplement list with your healthcare team. 

How to prevent 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.

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

• All women age 65 or older

• Postmenopausal women younger age 65 with at least 1 risk factor

In clinical practice, many healthcare professionals 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), National Osteoporosis Foundation (NOF), and Endocrine Society also recommend screening all men age 70 and older and men ages 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 transgender people (regardless of birth-assigned sex) starting at age 65

• Some people ages 50 to 64 with risk factors

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

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. Sometimes, a DEXA scan will show 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 comes down to treatment. Healthcare professionals recommend prescription medications — in addition to lifestyle changes — for most people diagnosed with osteoporosis. These treatments aim to lower 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:

Alex Eastman, PhD, RN

Alex Eastman, PhD, RN, is a California-based registered nurse and staff medical editor at GoodRx, where he focuses on clinical updates and Latino health.

Reviewed by:

Farzon A. Nahvi, MD

Farzon Nahvi, MD, is an emergency medicine physician and author of “Code Gray: Death, Life, and Uncertainty in the ER.” He works at Concord Hospital in Concord, New Hampshire, and teaches at the Geisel School of Medicine at Dartmouth.

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