Osteopenia

Osteopenia is not a disease but indicates low bone density, which is the preferred descriptive term. Low bone mass defined by bone mineral density is a T-score between -1.0 and -2.5 standard deviations.

By the age of 50, there is a high prevalence of low bone mass using the T-score between -1.0 and -2.5 standard deviations definition. Over 35% of women and 20% of men have bone density results in this range by age 50. With age, larger numbers of individuals are classified in the “low bone density” category.

Fracture Risk with Low Bone Density

Low bone density does not mean you will develop osteoporosis or are at risk for breaking a bone. Your evaluation should look beyond your DXA results to assess your overall risk of breaking a bone. You could be at low, medium, or high risk for fracture.

Even though you don’t have osteoporosis by bone density, the presence of additional risk factors could tip you into a higher risk category. Other risk factors, like family history of hip fracture, past history of a broken bone, medical illnesses (rheumatoid arthritis, diabetes), medicines (steroids, proton pump inhibitors), and lifestyle factors (alcohol, smoking, physical activity) in combination with low bone density may increase your risk.

Bone mineral density results combined with risk factors provide a more comprehensive evaluation of your risk for fracture. The fracture risk assessment tool, FRAX, was developed to help quantitate your future risk of fracture.  Your doctor will assess your overall risk of breaking a bone then develop a management plan to work on lowering your risk.

Treat if High-Risk 

The National Osteoporosis Foundation set treatment guidelines for individuals with low bone mass range bone mineral density results (T-score between -1.0 and -2.5) who were at high-risk for fracture. High risk is defined as your FRAX score for major osteoporotic fracture is 20% or greater over 10 years; or your 10-year probability of hip fracture is 3% or greater. If you are in the low bone mass (osteopenia) category by DXA scan and have FRAX score defined as high risk, treatment with a FDA-approved medicine is recommended.