Osteopenia is a condition in which the mineral density of bone is reduced compared with the norm but does not yet reach the threshold of osteoporosis. By densitometry this is a T-score from −1.0 to −2.5.
It is not a disease but rather a warning signal and an intermediate stage between healthy bone and osteoporosis. At the same time, a significant share of fractures occurs precisely in people with osteopenia, so it is not ignored.
Causes
Most often osteopenia is a natural consequence of age and the fall in estrogens after menopause. A shortage of calcium and vitamin D, smoking, alcohol and physical inactivity all contribute.
Loss can be accelerated by medications (glucocorticoids, anticonvulsants, proton-pump inhibitors) and diseases — hyperparathyroidism, malabsorption, rheumatoid arthritis. This is then called secondary osteopenia.
Osteopenia or osteoporosis — the difference
The difference is only in the T-score figure: from −1.0 to −2.5 is osteopenia, below −2.5 is osteoporosis. Osteopenia is the "yellow zone": the bone is weaker than normal, but the fracture risk is still moderate.
The paradox is that the absolute number of fractures in people with osteopenia is large — simply because there are far more such people than people with osteoporosis. So the decision on management is made not only by the T-score but also by a risk assessment (FRAX).
What to do
The basis is lifestyle: enough calcium and vitamin D, regular strength and weight-bearing exercise, balance training, quitting smoking and moderation with alcohol. Fall prevention matters too.
Medication for osteopenia is not prescribed to everyone, but for a high calculated fracture risk (for example, by FRAX a 10-year hip-fracture risk ≥ 3% or a major osteoporotic fracture ≥ 20%).
Reference ranges
Classification by densitometry (DXA) T-score, WHO:
| Normal | T ≥ −1.0 |
| Osteopenia | T from −1.0 to −2.5 |
| Osteoporosis | T ≤ −2.5 |
Calculate using this marker
Calculators where Osteopenia is used directly:
Frequently asked questions
Does osteopenia have to be treated with medication?
Often no. For osteopenia the basis is calcium, vitamin D and strength and weight-bearing exercise. Medication (bisphosphonates and others) is added if a FRAX calculation shows a high 10-year fracture risk.
Does osteopenia progress to osteoporosis?
It can, if the risk factors are not addressed. But with adequate calcium and vitamin D intake, regular exercise and quitting smoking, the loss of bone mass can be slowed or stopped.