What's the Difference?

Both osteoporosis and osteopenia refer to reduced bone density, but they differ in severity:

• Osteopenia: Low bone mass (mild to moderate bone loss); precursor to osteoporosis
• Osteoporosis: Severe bone loss; "porous bones" with significantly increased fracture risk

How are they diagnosed?

Both are diagnosed using a DEXA scan (Dual-Energy X-ray Absorptiometry), which measures bone mineral density (BMD) at the hip and spine. The result is reported as a T-score, which compares your bone density to that of a healthy 30-year-old adult.

T-Score Classification:

• Normal: T-score ≥ -1.0
• Osteopenia: T-score between -1.0 and -2.5
• Osteoporosis: T-score ≤ -2.5
• Severe Osteoporosis: T-score ≤ -2.5 + history of fragility fracture

What is Osteopenia?

Osteopenia means your bones are weaker than normal but not yet in the osteoporosis range. It's a warning sign that you're at increased risk for developing osteoporosis and fractures if steps aren't taken.

Important: Not everyone with osteopenia will develop osteoporosis. With proper management, progression can be slowed or prevented.

Risk Factors for Osteopenia/Osteoporosis:

• Age: Bone density peaks at age 30; gradual loss begins afterward
• Gender: Women (especially postmenopausal) at higher risk; men also affected
• Family History: Genetic predisposition
• Low Body Weight: BMI <20< /li>
• Ethnicity: Caucasian and Asian women at highest risk
• Menopause: Loss of estrogen accelerates bone loss
• Medications: Long-term steroids, certain cancer treatments, antiseizure drugs
• Lifestyle: Smoking, excessive alcohol, sedentary lifestyle
• Medical Conditions: Hyperthyroidism, hyperparathyroidism, celiac disease, rheumatoid arthritis, kidney disease
• Nutritional Deficiencies: Low calcium, low Vitamin D

Symptoms:

Both osteopenia and osteoporosis are "silent diseases"—no symptoms until a fracture occurs.

Fractures may cause:

• Back pain (from vertebral compression fractures)
• Loss of height
• Stooped posture ("dowager's hump")
• Bone breaks from minor falls or even coughing/sneezing

Treatment: Osteopenia

Goal: Prevent progression to osteoporosis and reduce fracture risk.

Lifestyle Changes:

• Weight-Bearing Exercise: Walking, jogging, dancing, stairs (30+ minutes most days)
• Resistance Training: Weights, resistance bands
• Balance Exercises: Tai Chi, yoga (to prevent falls)
• Quit Smoking
• Limit Alcohol: ≤1 drink/day (women), ≤2 drinks/day (men)

Nutrition:

• Calcium: 1000-1200 mg/day (women >50, men >70); from diet first, supplement if needed
• Vitamin D: 800-2000 IU/day; maintain blood level >30 ng/mL
• Protein: Adequate intake for bone health

Medications:

• Generally NOT needed for osteopenia unless high fracture risk (FRAX score indicates treatment)
• May be recommended if T-score approaching osteoporosis range or other risk factors present

Treatment: Osteoporosis

Goal: Prevent fractures, improve bone density.

Lifestyle + Nutrition: Same as osteopenia (above)

Medications (Usually Indicated):

• Bisphosphonates (First-Line):
  • Alendronate (Fosamax®) 70 mg weekly
  • Risedronate (Actonel®) 35 mg weekly
  • Ibandronate (Boniva®) monthly
  • Zoledronic acid (Reclast®) IV once yearly
• Denosumab (Prolia®): Injection every 6 months
• Selective Estrogen Receptor Modulators (SERMs): Raloxifene (for postmenopausal women)
• Hormone Replacement Therapy (HRT): For select postmenopausal women
• Anabolic Agents (Severe Cases):
  • Teriparatide (Forteo®), Abaloparatide (Tymlos®)—daily injections
  • Romosozumab (Evenity®)—monthly injections

FRAX Score: Who Needs Treatment?

The FRAX calculator estimates 10-year fracture risk based on age, gender, BMI, fracture history, parental hip fracture, smoking, alcohol use, glucocorticoid use, rheumatoid arthritis, and bone density.

Treatment recommended if:

• T-score ≤ -2.5 (osteoporosis)
• History of hip or vertebral fracture
• T-score -1.0 to -2.5 (osteopenia) + FRAX 10-year hip fracture risk ≥3% OR major osteoporotic fracture risk ≥20%

Monitoring:

• DEXA Scan: Repeat every 1-2 years (on treatment) or 2-5 years (osteopenia, no treatment)
• Vitamin D and Calcium Levels: Check periodically
• Monitor for Fractures

Can Bone Density Improve?

• Osteopenia: Lifestyle changes can stabilize or slightly improve bone density
• Osteoporosis: Medications (especially anabolic agents) can increase bone density; bisphosphonates usually stabilize and prevent further loss
• Main goal is fracture prevention, not just improving T-score