Osteopenia refers to the loss of bone mass caused by tobacco use, low calcium in the diet, and medications, among other causes. It’s less severe than osteoporosis, but it may progress into it if left untreated.
Osteoporosis and osteopenia are both conditions that affect the strength and health of your bones. The difference between the two lies in the level of bone damage.
Keep reading to learn more about the differences between these two conditions, how doctors diagnose levels of bone damage, and what you can do to protect your bone health.
Osteopenia and osteoporosis are diagnoses that are used to label bones that have weakened over time.
Bone strength can be measured with bone mineral density (BMD) scores. BMD measures the level of minerals — like calcium — in your bones, and a lower score means you’re at an increased risk of fractures or breaks.
Osteopenia can be considered the first step toward osteoporosis. Technically, it’s just a way of saying that your bone density is lower than normal but not yet causing real problems.
Bone density peaks around age 35, and as your bone density decreases, you may be diagnosed with osteopenia. Typically, this begins to occur with no symptoms at all, but if you begin to break or fracture bones easily, your doctor may decide to measure your bone density.
If you have a lower-than-normal bone density score — between -1 and -2.5 — you have osteopenia. If your score is lower than -2.5, you may be diagnosed with osteoporosis.
Osteoporosis is the more serious progression of osteopenia. As bone density decreases, the honeycomb-like structure inside your bones becomes even more porous. The more open spaces there are inside your bones, the more density and strength they lose.
The light, fragile bones that develop with osteoporosis can place you at a higher risk for fractures and breaks, even when you are doing simple daily activities.
Below are the T scores that identify if the person has osteopenia or osteoporosis.
| Osteopenia | Osteoporosis | |
|---|---|---|
| T score | -1 to -2.5 | -2.5 and lower |
The best way to diagnose osteopenia versus osteoporosis is with BMD testing. Your T scores will indicate the level of damage in your bones.
Everyone’s bones lose some mass and density over time. After 35, bone strength begins to decline, but there are certain risk factors that can accelerate this process.
People in the following categories are at an increased risk for developing osteopenia and, perhaps eventually, osteoporosis:
- being female
- being over the age of 35
- having a smaller, thinner frame
- having
Caucasian or Asian ancestry - having a history of poor nutrition lacking in certain minerals
- having a sedentary lifestyle
- smoking
- consuming alcohol
- going through menopause
- experiencing hormonal changes
- having thyroid disease
- taking certain medications like steroids
Since osteopenia usually develops without symptoms, you may not know that your bones are becoming weaker until you begin to have serious problems or the condition progresses to osteoporosis.
A primary care physician may screen you for your risk of osteopenia and osteoporosis. If you have an elevated risk for osteopenia or osteoporosis, your doctor may suggest bone density testing.
Bone density tests are usually done with dual-energy X-ray absorptiometry (DXA/DEXA) scans of the hip and lower spine.
This testing is also recommended for:
- women over age 65
- women under age 65 who have evidence of lower bone mass
- men over age 70
- men over age 50 with certain risk factors for bone loss
BMD measurements and your FRAX (Fracture Risk Assessment Tool) score are usually used together to get an idea of your overall bone health and guide treatment.
The best treatment for osteopenia is preventing further bone loss and progression of your condition to osteoporosis. While you can’t control your age or genetics, there are some things you can do to help slow bone loss.
Some strategies to reduce your risks of bone density loss include:
- stopping smoking, if applicable
- reducing alcohol consumption
- eating a balanced diet rich in vitamins and minerals
- taking vitamin and mineral supplements
- staying active, especially with weight-bearing exercises
If these strategies aren’t helping, or your condition has already advanced to osteoporosis, your doctor may prescribe you medications or treatments that can help prevent additional bone loss. These may include:
- bisphosphonates like alendronate (Fosamax) or ibandronate (Boniva)
- antibody therapies like denosumab (Prolia) and romosozumab (Evenity)
- hormone medications like procalcitonin
- hormone replacement therapy
- vitamin C supplements
- calcium supplements
- physical therapy
Bone loss is a natural part of aging, but there are some things — like one’s sex and diet — that can speed the process along.
If your bone density is lower than normal, you may be diagnosed with osteopenia. While this is not quite osteoporosis, the condition is still serious.
With osteopenia, you have time to make changes that can protect your bone health. If your condition has advanced to osteoporosis, talk with your doctor about what you can do to preserve your bone strength and prevent additional loss.