Osteopenia vs. osteoporosis: Understanding the difference

By: Bel Marra Health | Bone Health | Thursday, June 08, 2017 - 08:00 AM

osteopenia vs. osteoporosisWe often hear doctors using the term osteopenia and osteoporosis when referring to human bones, but there is a difference between the two. Understanding the difference can protect you and keep you mobile.

When we look at the words osteopenia and osteoporosis, it’s easy to see how the two can be confused. Aside from the similar spelling, the conditions both relate to bone density. The difference between osteopenia and osteoporosis comes down to the degree of decreased bone density. If a person has osteopenia, they do have decreased bone density, but not to the extent of someone who is suffering from osteoporosis.

Osteopenia can lead to osteoporosis, which in turn can cause bone fractures. When a doctor has had a chance to test bone density in an individual, they’ll decide if treatment is required for osteopenia. Not all people who have this condition need aggressive treatment. Osteoporosis is much more serious because even a minor fall or sneeze could lead to a bone fracture. Sadly, there are many people who don’t even realize they have osteoporosis or osteopenia. A lot of people discover they have osteoporosis after they experience a fracture. Fortunately, there are ways that we can all lower our risk of osteopenia and osteoporosis

Prevalence of osteopenia and osteoporosis

Now that we have established the difference between osteoporosis and osteopenia, it is important to be aware of the prevalence of each. Research shows that osteoporosis is a big problem in the United States. About 10 million Americans suffer from osteoporosis and an estimated 18 million are at risk of developing the problem. The American Academy of Orthopaedic Surgeons (AAOS) reports that females make up 80 percent of those who suffer from osteoporosis. Still, males also suffer from this disease. For reasons that are not fully understood, many cases among men go unreported. The National Osteoporosis Foundation estimates that the ailment is linked to at least two million broken bones every year.

Harvard Health suggests that about 50 percent of Americans over the age of 50 are impacted by osteopenia. Think about it—that’s half the population regardless of gender who are at risk of getting osteoporosis.

Osteopenia vs. osteoporosis bone density

Let’s take a look at the two conditions from a bone density perspective. Bone density is a measurement of the density and strength of bones. Peak bone density occurs around the age of 30, but after that, people gradually begin to lose bone mass. Around middle age, bone cells become reabsorbed by the body a lot faster than new bone cell grows. This means that bones lose minerals, mass, and structure, becoming weaker.

Bone density tests can measure the amount of calcium in bones and estimate the risk of bone fractures. Osteopenia is often diagnosed using simple radiographs, but the most widely used test, especially when it comes to determining if a person has osteoporosis, is the duel-energy x-ray absorptiometry (DEXA). It uses a low-energy x-ray that exposes a person to less radiation than a standard X-ray does and can measure calcium levels. The results of DEXA are measured as a “T-score” that is then compared to people with healthy bones.

Here’s what you should know about osteopenia vs. osteoporosis T-scores. Patients with T- scores that are -1 and above have normal bone density, and between -1 and -2.5 is a sign of osteopenia. If a person has a score of -2.5, they likely are suffering from osteoporosis. A rating called “Z-score” is a measurement above or below what’s considered normal for someone of a certain age, sex, weight, and ethnic origin. If a person gets a Z-score of -2 or lower, it might mean that something other than aging is causing bone loss.

Osteoporosis vs. osteopenia causes

There are both medical causes and lifestyle causes for osteopenia and osteoporosis. Sometimes, you can have a health condition that can trigger a decline in bone density. Knowing what contributes to osteoporosis and osteopenia allows you to then focus on prevention.

For many women, the issue of bone loss is related to hormones. Endocrinologists have worked with countless women who experience a significant drop in estrogen following menopause. Over time, this increases the risk of osteoporosis and fracture. Men experience a similar problem. They need testosterone and estrogen for good bone health. Since men convert testosterone into bone-preserving estrogen, it is important that they have sufficient testosterone levels. If a man experiences an unusual or unexpected fracture, the doctor will most likely evaluate him for a testosterone deficiency.

Most people have heard about the importance of calcium in the diet. Without calcium, we can’t rebuild new bone. We have to think of our bones as a holding tank for both calcium and phosphorus. In terms of calcium, we need a constant level in our blood because our organs, including our heart, muscles, and nerves, depend on it. When organs need calcium, they will steal it if they have to from bones. This, of course, can deplete the bones of this vital mineral. What you end up with are thin, brittle bones that are prone to fracturing.

The chart below summarizes the main medical and lifestyle causes of low bone density.

Medical causes Lifestyle causes
Eating disorders, such as anorexia and bulimia Lack of vitamin D
Untreated celiac disease Sedentary behaviour
Overactive thyroid Smoking
Certain medications, such as steroids, hydrocortisone, and antiseizure drugs. Too much alcohol
Certain treatments, such as chemotherapy or radiation Carbonated beverages
Estrogen deficiency (Women) Lack of calcium
Low testosterone (Men)
Other hormone imbalances



It is unfortunate that many medical conditions can lead to bone loss. Genetic diseases such as cystic fibrosis, digestive problems, and tumors infiltrate bones with abnormal cells. There are also cases where people are consuming enough calcium, but for some reason, their body just doesn’t want to trap calcium the way it should. Instead of being retained for the bones, the calcium exits the body through urine.

Those who do not exercise on a regular basis are putting themselves at a higher risk of getting osteopenia, and eventually osteoporosis. Weight-bearing exercises help build strong bones. Besides helping you with your bones, various forms of exercise are known to improve flexibility, gait, and balance—all of which can prevent a person from falling.

Osteopenia vs. osteoporosis symptoms

As mentioned earlier, Osteopenia and osteoporosis often go unnoticed until a person fractures a bone, but there are some signs and symptoms that can be experienced.

While osteopenia doesn’t seem to cause people pain or any other noticeable signs and symptoms, once it progresses to osteoporosis, a person may experience back pain, which can be the result of a fractured or collapsed vertebra, loss of height, a stooped posture, and frequent bone fractures.

Many bone fractures due to osteoporosis, such as a vertebral or hip fracture, can be extremely painful. At the same time, it is important to note that some fractures due to bone loss can be painless and go undiagnosed for a long time.

When a person suffers from osteoporosis, the most vulnerable bones tend to be those in the wrist, spine, shoulder, and hip. In some cases, people never fully recover from the fractures. In other situations, there is full or partial recovery and mobility is not lost.

Osteopenia vs. osteoporosis treatment

Treatment varies between the two conditions. For instance, a person with strong bones can maintain that strength by adopting healthy lifestyle choices. If you already have osteopenia, those same healthy lifestyle choices can lower your risk of developing osteoporosis. Exercises such as walking, stair climbing, dancing, and lifting weights can be helpful.

Diet is also important. For strong bones, dieticians and doctors will suggest a diet that is rich in calcium and vitamin D. Low-fat dairy products and cheese are good foods to eat.

While it is true that our body makes its own vitamin D when sunlight hits our skin, many people don’t spend enough time outside. Did you know that if you spend just a few minutes outdoors each day, you will get at least some of the vitamin D that you need? Some foods have vitamin D and some foods are fortified with it. Good sources include fish, egg yolks, and fortified breakfast cereals or juices.

Refraining from smoking and drinking less alcohol can also help you maintain good bone health. Studies show a strong connection between cigarette smoke and lower bone density.

If you or someone you care about suffers from osteoporosis or osteopenia, their treatment might look something like this:

  • Drug treatment such as alendronate, ibandronate, zoledronic acid, or risedronate.
  • Hormone therapy, including selective estrogen receptor modulators (SERMs), thyrocalcitonin, or parathyroid hormone.
  • Lifestyle changes such as consuming more leafy greens, dairy, soy, and enriched bread.
  • Physical activity like strength training, weight-bearing exercises, and low-impact aerobics.

If you suspect that you have osteopenia or osteoporosis, you should consult with a doctor before starting any new exercise program. While you do want to strengthen your bones, you also don’t want to do anything that could cause a fracture or other injury.

Osteoporosis takes a big toll on the person suffering from it as well as those around them. It also causes a huge economic toll. For example, in Europe, the disability associated with osteoporosis is reportedly greater than that created by cancers, with the exception of lung cancer. A survey by the International Osteoporosis Foundation shows that denial of personal risk by postmenopausal women, as well as a lack of discussion about osteoporosis with their doctor, has left too many people underdiagnosed and undertreated. As we age, we should all be talking with our doctors about how to secure our bone health.


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