Osteopenia vs Osteoporosis: Key Differences Explained

Osteopenia is a natural byproduct of aging. It is a condition characterized by a decrease in bone density due to a variety of different factors. When a bone decreases in density, it loses minerals such as calcium and phosphorus, which are integral to bone strength and resilience to stress. This loss in density makes bones weaker and more susceptible to fractures, amongst other complications. Although a natural phenomenon, osteopenia can be accelerated by certain medical conditions, lifestyle habits, and medications that weaken the skeletal system, allowing it to progress to osteoporosis. Osteoporosis, in common terms, is osteopenia that has progressed and worsened to a point where a person exhibits severe bone loss, increasing the risks of fractures, even from minor falls and trauma. Continue reading to learn more about the difference between osteopenia and osteoporosis, some of the major risk factors associated with these conditions, and therapies and treatments that decelerate this naturally occurring process.

What is Osteopenia?

Osteopenia is the medical term for loss of bone density. “Osteo-” is a Greek prefix, meaning “bone”, and “-penia” is a suffix referring to a deficiency. As we age, our body’s ability to absorb and retain calcium and phosphorus decreases, which causes osteopenia. Calcium is responsible for maintaining bone structure, and phosphorus works to create a bone’s structural integrity. With a decrease in these two minerals, our bones become more porous and less dense. Adding to this, our testosterone and estrogen hormone levels drop as we age. With a drop in these levels, bone resorption increases, adding to an already decreased availability of calcium and phosphorus, leading to worsening bone health.

Experts estimate that around one-third of adults over age 50 have some degree of bone loss. However, certain medical conditions, lifestyle habits, and medications can also cause or worsen osteopenia.

What is Osteoporosis?

Osteoporosis is the medical term for severe loss in bone mineral density and bone mass. If bone loss continues and is not treated, osteopenia can progress to osteoporosis.

Osteoporosis is a clinical diagnosis, typically confirmed through a combination of medical history, physical exams, and diagnostic tests. The most common test to diagnose osteoporosis is a bone mineral density test or DEXA scan. This scan measures the density of bones and compares it to a standardized bone density value of a healthy 30-year-old. Having untreated osteoporosis can lead to an increased risk of fractures occurring from minor falls and trauma. The most common fractures include vertebral fractures in the spine, fractures of the hip, and fractures of the wrist. It is important to treat osteoporosis as fractures can cause chronic pain, reduced mobility, and even disability. With the help of proper nutrition, weight-bearing exercise, and medications, one can help prevent fractures and decelerate osteoporosis.

Key Differences Between Osteoporosis vs Osteopenia

The main difference between osteopenia versus osteoporosis is the degree of bone density loss. As mentioned before, the bone mineral density scan allows clinicians to calculate a “T-score” that is expressed as a standard deviation, showing how much a patient’s bone density deviates from an average value. A T-score of -1.0 or higher denotes normal bone density. A T-score of -1.0 to -2.5 is considered osteopenia. Finally, a T-score below -2.5 is considered osteoporosis. Bone density testing and T scores are described in more detail below.

Symptoms of Osteoporosis vs Osteopenia

Osteopenia Symptoms

Osteopenia does not usually cause any symptoms. The bone loss occurs silently in the background. Osteopenia can only be diagnosed with bone mineral density testing. However, some people may have osteopenia pain, such as low back pain.

Osteoporosis Symptoms

Like osteopenia, osteoporosis may not cause any obvious symptoms. The first sign of osteoporosis is often suddenly breaking a bone, for example, a bone fracture following a minor fall that wouldn’t normally cause any problems. Osteoporosis-related fragility fractures can occur with minimal to no trauma, such as a simple fall or forceful movement.

Symptoms of osteoporosis may also include:

Height loss of more than 1 inch due to compression fractures in the spine.
Changes in posture, such as bending or stooping in a hunched posture.
Lower back pain from unknown vertebral fractures.
Limitations in mobility due to fractures in the spine or hip, making everyday activities difficult to perform.
Shortness of breath due to reduced lung capacity from compression of spinal discs.

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What Are the Causes and Risk Factors?

Lifestyle factors

People of all ages and genders can develop bone loss, but some people are at a higher risk. Risk factors for osteopenia and osteoporosis include:

Age above 50
Female gender
Smaller built or thin stature
Menopause
Lack of exercise
Smoking
Drinking too much alcohol (more than 2-3 drinks per day)
Drinking too much caffeine (more than 3 cups of coffee a day)
Family history of osteoporosis

Slow bone loss occurs naturally with age. Bones are living tissues that grow and remodel at different rates throughout life, so some decrease in bone density with age is natural. Researchers have found that you have peak bone mass at around age 25. After this age, the rate of bone breakdown exceeds the rate of new bone formation, causing you to lose bone density gradually.

Health Conditions Linked to Osteopenia and Osteoporosis

According to the National Osteoporosis Foundation, certain medical conditions can increase the risk of developing or worsening osteopenia and osteoporosis, for example:

Diabetes
Chronic kidney disease
Hyperthyroidism
Calcium and vitamin D deficiency
Malnutrition
Gastrointestinal disorders like inflammatory bowel disease or celiac disease
Cushing syndrome
Hormonal imbalances
Eating disorders such as anorexia
Autoimmune diseases such as rheumatoid arthritis, ankylosing spondylitis, or collagen disorders
Blood disorders such as multiple myeloma
Bariatric surgery leading to decreased absorptions of minerals.

Medications Linked to Low Bone Mass

Certain medications can reduce people’s bone density and increase the risk of osteopenia and osteoporosis. This can occur due to hormonal changes or decreased calcium absorption. For example:

Corticosteroids
Diuretics (water pills)
Proton pump inhibitors prescribed for acid reflux
Antiepileptic drugs prescribed to treat seizures
Anticoagulants or blood thinning medications
Hormone therapy for breast cancer or prostate cancer

How Osteopenia and Osteoporosis Are Diagnosed

Osteopenia and osteoporosis can be diagnosed with a bone density test, which is a type of X-ray called dual-energy X-ray absorptiometry (DXA or DEXA) that measures your bone mineral density (BMD).

Experts in musculoskeletal and skin diseases recommend bone density testing to screen for osteoporosis in all women over age 65 and some men over age 70 who are at high risk of low bone mass. In addition, a healthcare provider may recommend a bone density test if you suffer a broken bone after a minor injury, such as a simple fall or forceful movement.

Your BMD result is compared to 2 groups:

Healthy young adults (T-score)
Age-matched adults (Z-score)

T Score: The first comparison is with the BMD results of healthy young adults (age 25-35 of the same sex and race). Standard deviation (SD) is the difference between your BMD and the BMD of healthy young adults. The result is called your T-score.

A positive T-score means your bones are stronger than healthy young adults. A negative T-score means you have lower than average bone density.

Z-Score: The second comparison is with the BMD of someone who is your age, sex, race, height, and weight. Standard deviation (SD) is the difference between your BMD and the BMD of someone with the same demographics. The result is called your Z-score.

A low Z-score (below -2.0) is a warning sign that you have less than average bone mass or are losing bone mass more rapidly than expected for someone your age and gender.

The World Health Organization (WHO) has defined normal bone density, osteopenia, and osteoporosis as follows:

T-score within 1 SD (+1 or -1) of young adults indicates normal bone density.
T-score of 1 to 2.5 SD below (-1 to -2.5) in young adults indicates low bone mass or osteopenia.
T-score of 2.5 SD or more below (-2.5 or more) in young adults indicates osteoporosis.

Treatment Options

The most common treatment for osteopenia is to prevent the condition’s progression to osteoporosis. The most effective prevention tactics include diet and exercise.

Exercise

Weight-bearing exercise and regular physical activity help to strengthen bones and surrounding tissues like muscles, ligaments, and tendons. Your healthcare provider may suggest weight-bearing exercises such as walking, stair climbing, aerobics, tennis, basketball, and dance. Other physical activities like yoga, tai-chi, and pilates can help strengthen your muscles so that there’s less stress on your bones. You may benefit from learning the proper exercises and techniques from a trainer or physical therapist.

Diet and Supplements

Eating a well-balanced diet can ensure you’re getting all the vitamins and minerals necessary for bone health. Your healthcare provider may refer you to a registered nutritionist or dietitian to develop a bone-healthy eating plan.

Your healthcare provider might also recommend taking over-the-counter or prescription calcium and vitamin D supplements to support bone strength. Experts recommend that adults should get 1,000 to 1,200 mg of calcium every day and 600 to 800 International Units of vitamin D every day to maintain bone health. Some good sources of vitamin D include oily fish, red meat, egg yolk, and fortified foods like breakfast cereals and spreads.

Medical Treatments

Most people with osteopenia don’t need to take prescription medications. However, if you have osteoporosis, your healthcare provider may recommend treating it with one of the following medicines:

Hormone replacement therapy with estrogen or testosterone. Replacing hormones can help to prevent bone disease (osteoporosis) in postmenopausal women.
Bisphosphonates: This is a group of medicines that increases bone density by slowing breakdown of old bone. These drugs are available in pill and injection form and are dosed once daily, once weekly, once monthly, once every 3 months, or once a year. Examples include alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), and zoledronic acid (Zometa, Reclast).
Other osteoporosis medications may include:
- Calcitonin nasal spray (Miacalcin, Fortical).
- Parathyroid hormone analogs such as abaloparatide (Tymlos).
- Monoclonal antibodies such as denosumab (Prolia, Xgeva) and romosozumab (Evenity). Find out the pros and cons of Prolia.

Safety Tips

If a patient has osteoporosis, it is important to discuss general safety tips that would limit any falls or injuries. Some are listed below:

Wear the correct protective equipment when playing sports or doing physical activity.
Wear a seatbelt when in a vehicle and wear a helmet/protective padding when riding a bicycle or motorcycle.
Make sure to use safe and strong equipment such as ladders when reaching for things. Do not stand on tables, chairs, or stools.
Make sure living spaces are decluttered to limit the risks of falling.
Use assisted devices for walking such as a cane or a walker, if there are concerns with balance and coordination.

FAQs on Osteoporosis vs Osteopenia

Which Is More Serious: Osteopenia or Osteoporosis?

Osteoporosis is more serious than osteopenia. Osteopenia refers to lower-than-average bone mineral density for your age and gender. Osteoporosis refers to bone mineral density that is low enough to put you at risk of fractures.

At What Point Does Osteopenia Become Osteoporosis?

Osteopenia becomes osteoporosis if the standard deviation (SD) or difference in bone mineral density is more than 2.5 below the bone mineral density of healthy young adults. The WHO defines osteopenia as a T-score of -1 to -2.5 and osteoporosis as a T-score below -2.5.

What Organ Does Osteopenia Affect?

Osteopenia affects the bone tissue in the body. It can progress to osteoporosis, which can increase the risk of bone fractures.

How Worried Should I Be About Osteopenia?

You don’t have to worry about osteopenia, but you should take steps to stop its progression to osteoporosis. You can build strong bones by eating a healthy diet with enough vitamin D and calcium and getting regular weight-bearing exercise. A dietitian can help you include vitamin D and calcium-fortified foods in your diet. Also, talk to your healthcare provider about the need to take vitamin D and calcium supplements.

How Can You Prevent Osteoporosis?

While bone loss over time is natural, it is important to decelerate bone loss by eating a healthy diet rich in calcium and Vitamin D, staying active through weight-bearing and strengthening exercises, and limiting caffeine consumption, alcohol use, and smoking.