What Is Osteopenia?

Medically Reviewed by Jabeen Begum, MD on May 19, 2024
Written by Sarah Amandolare, Kristin Mitchell, WebMD Editorial Contributor
8 min read

Osteopenia is loss of bone density. If you have low bone density, your bones lack enough minerals, which makes them weak. Osteopenia can eventually become osteoporosis. About 40 million people in the U.S. have osteopenia. 

Your bones are usually at their densest when you’re about 25-30 years old. You lose bone density naturally as you age. Bone density loss affects roughly one-third of adults over age 50. Osteopenia, if it happens at all, usually occurs after age 50. The exact age it starts depends how strong your bones are when you're young. If they're hardy, you may never get osteopenia. If your bones aren't naturally dense, you may get it earlier.

Osteopenia vs. osteoporosis

Think of osteopenia as a midpoint between having healthy bones and having osteoporosis.

Osteopenia is when your bones are weaker than normal and your risk of getting osteoporosis and having broken bones increases. With osteoporosis, your bone density loss worsens and you're much more prone to fractures if you slip or fall.

Osteopenia – or seeing it turn into osteoporosis for that matter – is not inevitable. Diet, exercise, and  sometimes medication can help keep your bones dense and strong for decades.

You probably won't notice any symptoms if you have osteopenia. That’s why doctors often call it a "silent disease." But you could fracture a bone more easily after a minor fall or bump.

This condition happens when your body gets rid of more bone than it is creating.

Some people are genetically prone to it, with a family history of the condition. You're also more likely to get it if you're a woman or a person assigned female at birth (AFAB).

Women and people AFAB have lower bone mass than men and people assigned male at birth (AMAB). Also, people AFAB live longer, which means their bones age more, and they usually don't get as much calcium as people AMAB.

Calcium is the key to keeping bones healthy. Hormone changes that happen at menopause increase the chance of having osteopenia for people AFAB, and people AMAB with lower testosterone levels have higher odds of getting it.

Other risk factors include those that can lead to developing osteoporosis, which include:

  • Being a woman or a person AFAB and of White or Asian descent
  • Having surgery to remove your ovaries before menopause

 

 

 

Medical conditions, medical treatments, or lifestyle habits may cause osteopenia.

Medical osteopenia causes

Sometimes, you may have a medical condition or treatment that can trigger the condition. This might include:

Lifestyle osteopenia causes

Problems in your diet, lack of exercise, and unhealthy habits can contribute to this condition. Watch out for:

Osteopenia usually doesn't have any symptoms. This makes it hard to diagnose unless you have a bone mineral density test.

People with osteopenia will likely need regular bone density scans, every few years or so, to monitor bone changes and disease progression.

Osteopenia T-score

A noninvasive test called dual-energy X-ray absorptiometry (DEXA or DXA) can assess your bone density. It provides measurements called T-scores that may indicate osteopenia or osteoporosis. The scores also help determine your vulnerability to to bone fractures. A T-score ranging from -1 to -2.5 indicates osteopenia. A score below -2.5 is classified as osteoporosis. 

The National Osteoporosis Foundation recommends the test if you meet any of the following:

  • You’re a woman 65 or older.
  • You're a woman age 50-64 and have a high chance of breaking your bones due to the presence of other risk factors.
  • You’re a man age 50-69 or older than 65 with risk factors.
  • You break a bone after age 50.

The test is painless and fast. It uses X-rays to estimate how dense or thick your bones are.

Often, the first sign your bones are getting weak is when they break. Many people have a fracture or a series of fractures in their spine and don’t even know it. See your doctor if you have symptoms of a spinal fracture, which include:

  • Sudden, severe back pain
  • Back pain that gets worse when standing or walking, but gets a bit better when you lie down
  • Back pain when bending or twisting
  • Loss of height
  • A curved or stooped shape to your spine

As it's normal to lose bone density as you age, there's no real way to prevent osteopenia. Slowing bone loss and trying to build up your bone strength overall can help prevent osteopenia. These methods are similar to the recommended treatments for the condition. 

Even if you already have osteopenia, it's not too late for you to stop it from turning into osteoporosis. You can begin by talking with your doctor about an exercise plan that’s right for you andgetting enough calcium and vitamin D. 

 

 

 

 

Prescription medications are sometimes used to treat osteopenia if your bones are starting to get weak.

Medicines also used to treat osteoporosis might be prescribed. These include:

You might have side effects such as digestive problems and bone and joint pain. The drugs might also make you feel tired.

If treatments aren’t working, your doctor may prescribe other medications that treat osteoporosis. These include:

  • Abaloparatide (Tymlos)
  • Romosozumab (Evenity)
  • Teriparatide (Bonsity, Forteo)

The main complications of osteopenia are a higher risk of fracturing a bone and developing osteoporosis.

If you have osteopenia, you should focus on taking care of your bones. Lifestyle and dietary changes that support bone health can also benefit your overall health. Tips for living with osteopenia include: 

  • Exercise regularly, and stay as physically active as you can.
  • Make sure your diet includes enough vitamin D and calcium.
  • If you smoke, try to quit.
  • Cut down on carbonated drinks and alcohol.

Osteopenia diet

Getting enough calcium and vitamin D may be the most important thing you can do for your bones at any stage of life. You can get calcium in:

  • Dairy products such as yogurt, cheese, and milk (Go for low-fat or nonfat varieties.)
  • Spinach and broccoli
  • Dried beans
  • Salmon

Vitamin D, which helps your body absorb calcium, can be found in eggs and in oily fish such as salmon and sardines.

Some foods, including orange juice, cereal, and bread, have added calcium and vitamin D.

It's also a good idea to spend 10 to 15 minutes in the sun twice a week, because this helps convert inactive vitamin D to active form.

If your doctor doesn't think you're getting enough calcium and vitamin D, they may suggest that you take a supplement. Guidelines for vitamin D intake exist for different ages and situations such as pregnancy. 

The National Osteoporosis Foundation recommends the following calcium and vitamin D dosages:  

  • Women ages 50 and younger: 1,000 milligrams of calcium daily 
  • Women ages 51 and older: 1,200 milligrams of calcium daily
  • Men ages 70 and younger: 1,000 milligrams of calcium daily
  • Men ages 71 and older: 1,200 milligrams of calcium daily 
  • Most adults under age 50: 400-800 international units (IU) of vitamin D daily
  • Most adults ages 50 and older: 800-1,000 IU of vitamin D daily

Osteopenia exercises

Staying physically active is very important to strengthening your bones and preventing osteopenia from developing or worsening. 

Weight-bearing exercises, which require bearing your own body weight, can encourage stronger bones. Choose low-impact weight-bearing activities that won’t over-stress your bones, such as walking and climbing stairs. 

Activities that make your body work against gravity, such as yoga and tai chi, can also make you stronger while improving your balance. 

Weightlifting and other resistance exercises, such as using resistance bands, can boost your bone and muscle strength. 

A physical therapist can teach you which movements and exercises will be most helpful. Talk with your doctor before you start any exercise or strength training program. 

If you have osteopenia, you have bone density loss, which means your bones lack mineral density. This makes you more liable to break a bone.

Osteopenia often happens naturally with aging, but it’s never too early to take preventive steps. Talk with your doctor about an exercise plan that’s right for you. Eat the right kinds of food.

Even if you already have osteopenia, it's not too late for you to stop it from turning into osteoporosis. Adopting an active lifestyle and eating a healthy diet rich in calcium and vitamin D can help. 

What's the best treatment for osteopenia? Physical activity, vitamin supplements, and a healthy diet are the best treatments for osteopenia. These treatments can strengthen bone tissue and slow bone loss, helping prevent bone fractures and osteoporosis. 

Is osteopenia very serious? It’s not as severe as osteoporosis. But osteopenia can lead to serious complications, such as bone fractures, especially if you have other risk factors that make you more vulnerable to bone density loss. 

What is the fastest way to increase bone density? The best ways to build bone density are doing low-impact weight-bearing activities and eating a healthy diet rich in calcium and vitamin D. Your doctor may prescribe bone-building medicines if you have severe osteoporosis. 

What are the three worst bone density drugs?

  • Recent research suggests that Denosumab may carry a high risk of spinal fractures after people stop taking the drug. It’s important to take this medication consistently. 
  • Romosozumab (Evenity) may increase your risk of a heart attack, stroke, and death from heart disease. 
  • Hormone-related therapy, such as raloxifene (Evista), can increase the risk of blood clots and stroke. Estrogen may increase your risk of blood clots, breast cancer, endometrial cancer, and heart disease. But your age, health history, and the type of hormone therapy can affect your level of risk.