Low Bone Density or “Osteopenia”—What Does It Mean?

A bone density test lets you know if you have normal bone density, low bone density or osteoporosis. When your healthcare provider tells you that you have osteopenia, this means your bone density is somewhat low, but not low enough to be osteoporosis. The correct term for this is low bone density which used to be called osteopenia. If you have low bone density, your bone density may still be considered normal for you. 

You receive the result of your bone density test as a special number called a T-score. A T-score between –1.0 and –2.5 means you have low bone density. Examples are having a T-score of -1.2, -1.5, -2.0 and -2.2. A person with a T-score of -2.2 has lower bone density than a person with a T-score of -1.2.

If you learn that you have low bone density after your first bone density test, it does not necessarily mean you are losing bone. You may be a person whose bone density has always been lower than average. Some people never have normal bone density for a variety of reasons, such as genetics (your genes), body size or certain diseases and conditions. The older you are the more likely you are to have low bone density.

Only after your second bone density test will you know if you are losing bone density. Your healthcare provider will compare your second bone density test to your first one to find out if your bone density is staying the same or changing. Small changes in your bone density test result may not mean you are losing bone. You may even need a third or fourth bone density test to know for sure.  

Osteopenia is not a disease but it may mean that you have a greater chance of getting osteoporosis if you lose bone in the future.  This is because you have less bone to lose. When people with low bone density start losing bone, they are more likely to break a bone compared to people with higher bone density.

Protecting Your Bones

If you find out you have low bone density, now is a good time to make sure you’re taking steps to protect your bone health. Here's a quick checklist for keeping your bones strong and healthy:

• Get enough calcium every day. This is important throughout your life for healthy bones. Women under age 50 need a total of 1,000 milligrams (mg) of calcium and men under age 50 need a total of 1,000 milligrams (mg) of calcium. Women age 50 and older need a total of 1,200 mg of calcium. Men age 50-70 need a total of 1,000 mg of calcium and men age 71 and older need a total of 1,200 mg of calcium. If you get enough calcium from the foods you eat, then you don’t need to take a supplement. The total amount of calcium you get includes the calcium in the foods you eat, plus your multivitamin and supplements.
• Be sure to get your vitamin D. Adults age 50 and under need 400-800 international units (IUs) of vitamin D every day. Adults age 50 and older need 800-1,000 IUs of vitamin D every day. Some people may need more. There are several ways to get vitamin D: from sunlight, a few foods, multivitamins, supplements and medicines.
• Make exercise a part of your routine every day. You need to exercise regularly to keep your bones strong and healthy. Two types of exercises are important for bone health:
  • weight-bearing exercises, such as walking, running and jumping rope
  • muscle-strengthening exercises, such as weight lifting and using exercise bands and resistance machines
• Be careful with salt, caffeine and cola drinks. Too much is not good for your bones.
• Don’t smoke. Smoking is bad for your bones for many reasons.
• Avoid too much alcohol. Heavy drinking weakens bones. Drinking more than two to three alcoholic drinks a day can harm your bones.
• Talk to your healthcare provider. Make your healthcare provider your partner in keeping your bones strong.

Taking an Osteoporosis Medicine

If you have low bone density, your healthcare provider may recommend an osteoporosis medicine.

Decisions about when to take a medicine to prevent bone loss are complex. In addition to your bone density test result, your healthcare provider looks at:

• Your age
• Your gender
• If you have broken a bone in the past
• Your chance of breaking a bone in the future using the FRAX™ tool
• Other diseases or conditions you have
• Medicines you take
• Your lifestyle
• Your family medical history
• Your chance of falling
• Other factors

Discuss with your healthcare provider if a medicine is right for you at this time. Be sure to talk about the risks and benefits of taking (or not taking) a medicine. Once you start an osteoporosis medicine, you need to see your healthcare provider at least once a year to decide if you need to keep taking it. 

Absolute Fracture Risk

In the past, healthcare providers knew when to treat people with osteoporosis, but it was sometimes not clear when to treat patients with low bone density. If your bone density test shows that you have low bone density or osteopenia, the fracture risk assessment tool called FRAX can help estimate your chance of breaking a bone within the next 10 years. This makes it easier to decide whether you might benefit from taking an osteoporosis medicine. The FRAX tool uses information about your bone density and other risk factors for breaking a bone to estimate your 10-year fracture risk.

If you have low bone density, your DXA report may include your FRAX score along with your bone density. If it doesn’t, your healthcare provider can find out your FRAX score using a web-based version. The FRAX tool can be used to guide decisions about treatment in people who meet the following three conditions:

1. Postmenopausal women or men age 50 and older
2. People with low bone density (osteopenia)
3. People who have not taken an osteoporosis medicine

Additional Related Topics

Having a BMD Test - more information on bone density testing and test results.

Calcium: What You Should Know - information about calcium and how it relates to bone health.

Vitamin D and Bone Health - information about vitamin D and how it relates to bone health.

Exercise for Healthy Bones - information about exercise.

Absolute Fracture Risk - information on the FRAX tool.

Osteoporosis Medicines: What You need to Know - information about the osteoporosis medicines.