Osteopenia and osteoporosis are both conditions characterized by bone mass that is lower than the average for a young healthy normal woman. In osteoporosis, the bone mass is low enough that the risk of breaking a bone is too high, and often treatment is needed to strengthen the bone.
In contrast, osteopenia, also called low bone mass, is not a disease. In osteopenia, bone mass needs to be monitored but often does not require medical treatment. Knowing the basics about osteopenia vs osteoporosis will help you better navigate your diagnosis and treatment options.
This article will explore the differences – and similarities – between these two conditions, offering insights into their respective impacts on bone health and fracture risk. It will also provide you with tangible treatment options for both, so you can take proactive steps towards managing either condition while setting yourself up for healthy and active aging.
The difference between osteoporosis and osteopenia
Osteoporosis and osteopenia are both bone health conditions but they differ in terms of severity. Osteopenia is a precursor to osteoporosis and is characterized by lower-than-normal bone density. This could be related to body and bone size, genetic factors during youth and/or the bone loss that is universal as women approach or transition through menopause. While individuals with osteopenia have a higher risk of developing osteoporosis, the bone loss is not advanced. We’ll discuss bone density testing later in this article.
Osteoporosis
Osteoporosis is a more advanced stage of bone loss. In this condition, bones are significantly porous and fragile, increasing your risk of fractures even during normal daily activities like making a bed, sneezing, or having a minor fall. These fractures can be debilitating and have life changing consequences. The most common fracture sites in someone with osteoporosis are the bones of the spine, hip, and wrist, but fractures of any bone can occur in people with osteoporosis.
Osteopenia
Osteopenia serves as an early warning sign, prompting preventive measures, while osteoporosis requires more comprehensive management to prevent further bone deterioration and fractures. Regular bone density tests and early intervention can play a crucial role in managing both conditions effectively.
Essentially, the key difference lies in the degree of bone density loss and the associated risk of fractures.
How are osteoporosis and osteopenia diagnosed?
Diagnosing osteoporosis vs osteopenia involves assessing bone density through a specialized test called a bone mineral density (BMD) test or DXA scan (dual X-ray absorptiometry). These tests measure the amount of mineral content in specific areas of bones, typically the spine, hip, and forearm. The results are then compared to the bone density of a healthy young adult, providing a T-score.
Osteopenia vs osteoporosis DXA scan
As mentioned, a DXA scan is the best way to measure bone density. It is quick, harmless, and accurate, and can help determine if you have osteopenia or osteoporosis. It is possible that you could have osteopenia at one part of your skeleton and osteoporosis in another.
Regular screenings and early detection are crucial for effective management. Healthcare professionals use this diagnostic tool to assess bone health, determine the level of risk, and develop appropriate strategies for prevention and treatment.
Osteopenia vs osteoporosis T-score
Normal bone density includes women with T-scores as low as -1.
For osteopenia, the T-score falls between -1.0 and -2.5 standard deviations below that of a healthy young adult, indicating lower-than-normal bone density but not to the extent seen in osteoporosis. The osteopenia category is very broad – many postmenopausal women have osteopenia. Their bone density can be close to normal range (T-scores between -1 and -1.5) or close to osteoporosis range (T-scores of -2 to -2.5) (Bone Health and Osteoporosis Foundation, nd). Women with T-scores close to normal range in their 50s or 60s are likely never to develop osteoporosis.
Osteoporosis is diagnosed when the T-score is -2.5 or lower, signifying a more severe reduction in bone density. Additionally, a diagnosis may be made if an individual has experienced a fracture from osteoporosis, even without a formal BMD test. Most adulthood fractures that occur in falls, in the absence of major trauma such as being hit by a moving vehicle, are related at least in part to osteoporosis. If you have a fracture, you should be evaluated for the likelihood of osteoporosis.
Osteopenia vs osteoporosis treatment
Treatment approaches for osteopenia vs osteoporosis differ based on the severity of bone density loss.
Osteopenia treatment
For osteopenia, lifestyle modifications often take precedence, including a focus on adequate nutrition. This includes plant products, calcium and vitamin D intake, weight-bearing aerobic and strengthening exercises, and lifestyle changes such as quitting smoking and moderating alcohol consumption. In some cases, healthcare providers may recommend medications to prevent further bone loss (Bone Health and Osteoporosis Foundation, 2022). Osteopenia can progress to osteoporosis if not treated properly.
Osteoporosis treatment
Osteoporosis, being a more advanced stage of bone loss, typically requires a more targeted intervention. Medications, such as bisphosphonates, hormone therapy, raloxifene or denosumab, may be prescribed to enhance bone density and reduce the risk of fractures. For people with recent or multiple fractures, or very low bone density, bone building medications (abaloparatide, teriparatide, romosozumab), which are given by daily or monthly injection, may be recommended. In addition, similar lifestyle modifications, including proper nutrition and bone-building exercises, remain crucial in the management of osteoporosis long-term.
Regular monitoring and follow-up bone density tests can help assess the effectiveness of your treatment plan, allowing for adjustments as needed. The key is to tailor the treatment approach to the individual's specific condition, health status, and risk factors to optimize bone health and minimize the risk of fractures.
Osteoporosis vs osteopenia FAQ
Which is more serious, osteopenia or osteoporosis?
Osteoporosis is more serious than osteopenia. While osteopenia indicates lower-than-normal bone density, osteoporosis represents a more advanced stage of bone loss that significantly increases your risk of fractures.
At what level does osteopenia become osteoporosis?
Osteopenia becomes osteoporosis when your T-score (bone density score from a DXA scan) falls to -2.5 or lower. When it comes to osteoporosis vs osteopenia, your T-score and fracture history will be the best indicator of subsequent fracture risk and treatment options.
What is the best thing to do for osteopenia?
The best thing to do for osteopenia is to incorporate a combination of lifestyle modifications and, in some cases, medication to prevent osteopenia from becoming osteoporosis. Getting enough fruits and vegetables, calcium and vitamin D, engaging in weight-bearing and muscle strengthening exercises, quitting smoking, moderating alcohol consumption, and consulting with healthcare professionals for personalized guidance and treatment options is key.
