What is Osteopenia?

Osteopenia is a condition where your bones have lower bone density than normal, but not low enough to be classified as osteoporosis. Think of it as a midpoint between healthy bone and osteoporosis. Bones with osteopenia are weaker than average, which increases the risk of fractures over time, especially if bone loss continues unchecked.

Because osteopenia usually develops silently, many people don’t know they have it until they undergo a bone density test.

Causes

Osteopenia develops when the body loses bone faster than it can rebuild it. Common causes and risk factors include:

  • Natural aging – bone density peaks around age 25–30, then gradually declines

  • Sex and hormones – women (especially after menopause) are at higher risk due to lower estrogen levels; men with low testosterone are also at risk

  • Family history – genetics play a role in bone strength

  • Lifestyle factors – smoking, excessive alcohol use, sedentary lifestyle, poor nutrition

  • Low calcium or vitamin D intake – essential for bone health

  • Medical conditions – hyperthyroidism, diabetes, chronic kidney disease, rheumatoid arthritis, eating disorders

  • Medications – long‑term use of corticosteroids, seizure medications, hormone therapies, or proton pump inhibitors

Symptoms

Osteopenia is often called a “silent condition” because it usually causes no noticeable symptoms. The first sign may be a fracture after a minor fall or injury.

Diagnosis

Osteopenia is diagnosed with a bone density test (DEXA scan).

  • Results are given as a T‑score:

    • Normal: –1.0 or higher

    • Osteopenia: –1.0 to –2.5

    • Osteoporosis: –2.5 or lower

  • Doctors may also use the FRAX tool to estimate 10‑year fracture risk, combining bone density with other risk factors.

Nonsurgical Treatment

The goal of treatment is to slow bone loss and prevent osteoporosis. Common strategies include:

  • Exercise – weight‑bearing and resistance training (walking, yoga, Pilates, light weights)

  • Nutrition – adequate calcium and vitamin D intake through diet or supplements

  • Lifestyle changes – quit smoking, limit alcohol, maintain a healthy weight

  • Fall prevention – balance training, home safety modifications

  • Medications – usually not prescribed for osteopenia alone, but may be considered if fracture risk is high (e.g., bisphosphonates, hormone therapy, or newer bone‑strengthening drugs)

When is Medication Needed?

Medication may be recommended if:

  • You have osteopenia and a high fracture risk (based on FRAX score)

  • You’ve already had a fragility fracture (hip, spine, or wrist)

  • You have other risk factors such as long‑term steroid use or certain chronic diseases