Orthopedics Osteoporosis What You Need to Know About Osteopenia Measuring, Risk Factors and Treatment By Carol Eustice Carol Eustice Facebook Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis. Learn about our editorial process Updated on April 18, 2020 Medically reviewed by Scott Zashin, MD Medically reviewed by Scott Zashin, MD LinkedIn Scott J. Zashin, MD, is board-certified in internal medicine and rheumatology. He was a volunteer clinical professor of internal medicine at the University of Texas Southwestern Medical School Dallas. Learn about our Medical Expert Board Print Osteopenia is defined as low bone density caused by bone loss. Osteopenia is often a precursor to osteoporosis, a common condition of brittle bones that can result in fracture. The two medical terms are sometimes confused and it's important to know the difference and how each is related to arthritis. The biggest difference between osteopenia and osteoporosis is that osteopenia is not considered a disease while osteoporosis is. Instead, osteopenia is considered a marker for risk of fractures. Stigur Karlsson / E+ / Getty Images Osteopenia Explained Osteopenia results when the formation of new bone does not occur at a rate which can offset normal bone loss. Bone density scans have made this easier to measure. Prior to bone density testing, radiologists used the term osteopenia to describe bones that seemed more translucent than normal on X-ray, and the term osteoporosis described the occurrence of vertebral fracture. Bone mineral densitometry, or bone density scans, changed those definitions: Osteoporosis is defined by a T score of -2.5 or lower and osteopenia is defined by a T score higher than -2.5 but lower than -1.0. The T score is your bone density compared with what is normally expected in a healthy young adult of your sex. A T score above -1 is normal. Using this criteria, 33.6 million Americans have osteopenia. The significance of that statistic is similar to identifying who is pre-hypertensive or those who have borderline cholesterol. In other words, identifying a group that is at risk for developing a disease. Other Risk Factors for Fracture Osteopenia is only one risk factor for fracture. Other risk factors include: Previous fracture Age (risk of fracture increases with age) Smoking (weakens bones) Drinking more than two alcoholic drinks per day (increases risk of hip fracture) Low body weight (increases risk of hip fracture) Race and gender (white women have two or three times risk compared to men or black and Hispanic women) Having a parent who had a hip fracture Sedentary lifestyle Inadequate calcium and vitamin D intake Conditions that increase the risk of falling such as poor vision, poor footwear, medical conditions that affect balance, use of sedative medications, or a history of falls Taking certain medications, including corticosteroids can result in glucocorticoid-induced osteoporosis Having certain medical conditions, such as rheumatoid arthritis or other rheumatic diseases can cause secondary osteoporosis Prevention Lifestyle changes can slow the progression of bone loss and decrease the risk of fractures. Lifestyle changes that can help prevent fractures include: Maintaining a healthy weight Participating in regular exercise, including weight-bearing exercise (walking, running, hiking, and tennis are examples of weight-bearing exercise, while swimming is non-weight-bearing) Make sure you have enough vitamin D and calcium in your diet or by taking dietary supplements No smoking 1:10 The Best Exercises to Prevent Osteoporosis Having regular bone density tests can help slow the progression of bone loss and decrease the risk of fractures by monitoring bone density measurements. The U.S. Preventive Services Task Force (USPSTF) found good evidence that bone density measurements accurately predict the risk for fractures in the short-term and formulated these recommendations for osteoporosis screening. Treatment Medications are used to treat osteoporosis, but healthcare professionals who treat patients showing signs of early bone loss don't always agree on the best course. Should patients with osteopenia be treated with medications to prevent progression to osteoporosis? The National Osteoporosis Foundation, the American Association of Clinical Endocrinologists, and the North American Menopause Society recommend treating people with osteoporosis or fracture. Still, there is inconsistency in what is recommended for people with osteopenia. Is treating osteopenia necessary or even cost-effective? Many experts believe that treating osteopenia with medications would not be cost-effective. But with additional risk factors, such as corticosteroid use or having rheumatoid arthritis, treating osteopenia becomes more of a consideration. It's important to remember that T scores alone cannot predict which patients with osteopenia will have fractures and which patients will not. Assessing all of the risk factors is the best way to decide whether treatment with osteoporosis medications is indicated. Patients with signs of early bone loss should focus on lifestyle modifications and discuss the benefits and risks of osteoporosis medications with their doctor. In patients with osteopenia but no history of fracture, doctors will use a calculator to develop a metric called FRAX that helps decide who might benefit from prescription medication to decrease fracture risk. In patients with a 3% risk of a hip fracture over 10 years or a 20% chance of fracture elsewhere, prescription medication may be recommended. 8 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Varacallo M, Pizzutillo P. Osteopenia. In: StatPearls. Berger A. Bone mineral density scans. BMJ. 2002;325(7362):484. doi:10.1136/bmj.325.7362.484 Sheu A, Diamond T. Bone mineral density: testing for osteoporosis. Aust Prescr. 2016;39(2):35–39. doi:10.18773/austprescr.2016.020 Office of the Surgeon General (US). The frequency of bone disease. Unnanuntana A, Gladnick BP, Donnelly E, Lane JM. The assessment of fracture risk. J Bone Joint Surg Am. 2010;92(3):743–753. doi:10.2106/JBJS.I.00919 Office of the Surgeon General (US). Lifestyle approaches to promote bone health. Kling JM, Clarke BL, Sandhu NP. Osteoporosis prevention, screening, and treatment: a review. J Womens Health (Larchmt). 2014;23(7):563–572. doi:10.1089/jwh.2013.4611 The U.S. Preventive Services Task Force. Final recommendation statement osteoporosis to prevent fractures: screening. Additional Reading Khosla MD, Sundeep. et al. Osteopenia. The New England Journal of Medicine. Payne, January W. Does Early Bone Loss Mean You Need Drugs? U.S. News and World Report. Cummings MD, Steven R. A 55-Year-Old Woman With Osteopenia. The Journal of the American Medical Association. Torpy MD, Janet M. Osteopenia and Preventing Fractures. The Journal of the American Medical Association. By Carol Eustice Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit