What is osteopenia?

Osteopenia is bone density that is somewhat low. A World Health Organization committee defined four diagnostic categories: Normal, Osteopenia, Osteoporosis, and Established Osteoporosis. These categories depend on bone density and presence of fractures. For example, using the Hologic bone densitometer, osteopenia is a bone density at the total hip between .637 and .820 g/cm2. Using the Lunar brand, osteopenia is between .706 and .886. Bone density can also be reported in units called "T-scores", and osteopenia is between T-score of -1 and -2.5.

Bone density naturally declines with age. By definition, 16% of young white women (one out of six) have osteopenia. Osteopenia is not a disease! By age 65 years about half of the women in the USA will have either osteopenia or osteoporosis, and by age 80 almost all women have had some bone loss and bone density will show either osteopenia or osteoporosis.

It is important to remember that the risk of getting a fracture (broken bone) is more important than the measurement of bone density. Fracture risk depends on many other factors, especially age. At the same bone density, the risk of fracture doubles every ten years. Other risks include poor general health, unsteady balance, presence of a fracture, and low weight.

Treatment of osteopenia depends on age and risk factors

Premenopausal women
In healthy women who still have regular menstrual periods, prescription medications should not be used for osteopenia, because the long-term safety and effectiveness has never been demonstrated. Women should eat a healthy diet, maintain a sturdy weight, get exercise, and not smoke. Women with chronic diseases or infrequent periods may be at a higher risk and they should consult their physicians.

Early postmenopausal women
For healthy women between 50 and 60, osteopenia is not an immediate threat, but if no preventive medications are given, women will develop osteoporosis as they get older. Calcium, vitamin D and exercise are important but probably not enough to prevent osteoporosis in later life. We still don't know the best medications for this group of women! (see the handout on choices for this group). There is no "one size fits all" recommendation.

Older postmenopausal women
Those women who have lived over 80 years and have osteopenia are above average! If they are healthy and without fractures they don't need prescription medication for their bones. They should eat enough protein and calcium, take vitamin D, maintain a sturdy weight, get exercise, and not smoke. Women above age 65 should need prescription medications only if they have "osteoporosis" (DEXA T-score less than -2.5) or if they have other medical complications placing them at high risk.

Here is a link to a JAMA patient info page about osteopenia.

Susan Ott, M.D.
2/7/07