Osteopenia

Osteopenia is a condition in which bone mineral density is lower than normal but not low enough to be classified as osteoporosis. It is usually diagnosed when the T-score on a dual-energy X-ray absorptiometry (DXA) scan falls between −1.0 and −2.5 at the lumbar spine, hip, or femoral neck. Osteopenia signals an increased risk of fractures, especially if bone loss continues, but it does not always lead to fractures.

Risk factors include aging, female sex and menopause, family history, smoking, excessive alcohol use, low body weight, sedentary lifestyle, and chronic use of glucocorticoids or other medications. Nutritional deficiencies in calcium and vitamin D, as well as certain medical conditions, can contribute to lower bone density.

Diagnosis involves DXA imaging and assessment of fracture risk, often with the FRAX tool. Z-scores are used for younger individuals. Regular follow-up DXA scans may be recommended to monitor changes in bone density.

Management focuses on reducing fracture risk through lifestyle measures, adequate calcium (about 1000–1200 mg daily) and vitamin D (often 800–1000 IU daily), and weight-bearing or resistance exercise. Fall prevention is important. Pharmacologic therapy may be considered for those at high fracture risk, using agents such as bisphosphonates, denosumab, or selective estrogen receptor modulators.

Osteopenia can progress to osteoporosis if bone loss continues, but progression is not inevitable. Regular assessment and individualized management help reduce fracture risk.