Osteopenia is a lower-than-normal bone mineral density that often occurs after the age of 35. This condition may progress into osteoporosis, but it’s possible to reverse with lifestyle changes.
Osteopenia isn’t a disease. It’s characterized by a lower bone mineral density (BMD) than usual. However, having osteopenia does increase your chances of developing osteoporosis.
You can take action to help prevent osteopenia. The right exercises and food choices may help keep your bones strong.
Osteopenia doesn’t usually cause symptoms. Decreasing bone density doesn’t cause pain.
After your bone mass peaks, ideally around age 30, your body breaks down old bone faster than it builds new bone.
That means you lose some bone density, and your bones may become more brittle.
Anyone can develop osteopenia — it’s estimated that
- being female
- a family history of low BMD
- being older than age 50
- early menopause before age 45
- removal of ovaries (oophorectomy) before menopause
- a lack of exercise
- a diet lacking calcium or vitamin D
- smoking or using other forms of tobacco
- heavy alcohol consumption
- certain medications, such as steroids or anticancer agents
Menopause
If you have ovaries or a uterus, your bones may become brittle more quickly after menopause due to lower estrogen levels, as estrogen may help support your bones.
During and after this transition, your bone density levels may drop low enough to be considered osteopenia.
Pre-existing conditions
Pre-existing health conditions or disorders may increase your risk of developing osteopenia, including:
- anorexia
- bulimia
- Cushing syndrome
- hyperparathyroidism
- hyperthyroidism
- inflammatory conditions like rheumatoid arthritis, lupus, or Crohn’s disease
- diabetes
- autoimmune conditions, such as celiac disease
Who should be tested for osteopenia?
The Bone Health and Osteoporosis Foundation (BHOF) recommends a BMD test if you’re:
- a woman age 65 or older
- younger than 65, in postmenopause, and have one or more risk factors
- in postmenopause and have broken a bone from an everyday activity, like pushing a chair to stand up or vacuuming
Your doctor may recommend a BMD test for other reasons. Speak with them for their advice.
DEXA test
Dual-energy X-ray absorptiometry, DEXA or DXA, is the most common way to measure BMD. It’s also known as a bone mineral density test. It uses X-rays with lower radiation than a typical X-ray and is painless.
If you’re older than age 65, your doctor will likely suggest a DEXA scan at least once to look for bone loss.
DEXA usually measures bone density levels in your:
- spine
- hip
- wrist
- finger
- shin
- heel
DEXA compares the density of your bone to the density of a 30-year-old of the same sex and race. The result of a DEXA is a T-score, which your doctor can use to provide a diagnosis:
| T-score | Diagnosis |
|---|---|
| -1 or above | typical bone density |
| -1.1 through -2.4 | low bone density, indicates osteopenia |
| -2.5 or below | high risk for fracture, indicates osteoporosis |
If your T-score shows you have osteopenia, your DEXA report may include your fracture risk assessment tool (FRAX) score. If it doesn’t, your doctor can calculate it.
The FRAX tool uses your bone density and other risk factors to estimate your risk of breaking your hip, spine, forearm, or shoulder within the next 10 years. It can also help your doctor make decisions about treatment for osteopenia.
The goal of treatment is to keep osteopenia from progressing into osteoporosis.
The first part of treatment and osteopenia prevention involves diet and exercise choices.
The risk of breaking a bone when you have osteopenia is fairly small, so doctors don’t usually prescribe medication unless your BMD is close to the osteoporosis level.
Your doctor might talk with you about taking a calcium or vitamin D supplement, although generally, it’s better to get enough of each from your diet.
Q: Can osteopenia be reversed?
A: Osteopenia can be stabilized and even improved. Your goal is to identify the risk factors and change the ones you can. For instance, stopping smoking, minimizing steroid dosages, or effectively controlling inflammation associated with diseases like rheumatoid arthritis. Diet and exercise can improve bone density.
— Nancy Carteron, MD, FACR
Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
Diet
Dairy products are great sources of vitamin D:
- cheese
- milk
- yogurt
But if you don’t or can’t eat dairy, some types of orange juice, breads, and cereals, are fortified with calcium and vitamin D. Yet even more foods with calcium include:
- dried beans
- broccoli
- wild freshwater salmon
- spinach
The BHOF’s recommendation for adults over 50 years is 1,200 milligrams (mg) of calcium daily (from food and supplements) and 800 to 1,000 international units (IU) of vitamin D.
Another way to get vitamin D is with a
Exercise
- have osteopenia
- are a young adult
- are a premenopausal female
These are all examples of weight-bearing exercises, which means you do them with your feet touching the ground. While swimming and biking may help your heart and build muscle, they don’t build bone.
Even small increases in BMD can significantly reduce your risk for fractures later in life. So if you can’t find 30 minutes to exercise most days, focus on moving more in general.
However, as you get older, it becomes harder for you to build bone. With age, your exercise should emphasize muscle strengthening and balance as well.
Walking is still great, and now swimming and biking count, too. These exercises can help reduce your chances of falling.
Speak with your doctor about the best and safest exercises for you.
If you need help making healthy changes
Modifying your lifestyle can be hard work, especially if you don’t know where to start. That’s why we created a three-day email series called “New Habits, New You” to help guide you. Join today!
Avoid substance use
If you smoke or drink alcohol, try to avoid it — especially if you’re younger than age 35 when you can still build bone. Speak with your doctor about smoking cessation if you need help quitting.
Your bone density peaks around your 30s. After that, it becomes harder to build bone, and you become more prone to brittle and broken bones as you get older.
If your bone mineral density T-test score is between -1.1 and -2.4, this indicates osteopenia. You still have the chance to reverse it before developing into osteoporosis.
Make sure you’re getting enough vitamin D — about 800 to 1,000 IU for most adults — and calcium — about 1,200 mg for most adults — through your diet, supplementation, or both. Exercise and other lifestyle changes may help, too.