Osteopenia vs. Osteoporosis

It’s a dreaded and genuine concern of aging, especially in post-menopausal women, but truly for all aging adults. Osteoporosis affects almost 20% of women 50 and older and nearly 5% of their male counterparts. Osteoporosis, however, is not a disease that we inevitably acquire. It is a progression of bone loss due to several natural aging and environmental factors. When we are young, our bones continuously break down and rebuild themselves. We reach peak bone density – strength and thickness of bone — sometime between 25 and 35 years of age, at which time the rate of bone loss begins to overtake bone regeneration. This is normal and nothing to be concerned about. Female patients can lose 2% of their bone mass every year after menopause.

Because osteoporosis is progressive, there can be signs of bone mineral loss, typically found during routine annual physicals with your primary care physician. If your doctor believes you may be at higher risk, they may prescribe a diagnostic tool, such as a non-invasive DEXA (dual-energy x-ray absorptiometry) scan to determine a person’s bone mineral density score (BMD) or T-score.

These diagnostics are invaluable as a preemptive and proactive measure of bone strength and can help us catch early signs of bone loss, known as osteopenia. Osteopenia is simply bone density loss before it has reached the severity of osteoporosis. It is the warning signal that a shift has taken place and that steps must be taken. When it’s taken seriously and treated early, the worsening of osteopenia to “full-blown” osteoporosis can be halted, and the risk of fracture and other bone problems may be reduced.

It is important to remember that osteopenia and osteoporosis are not synonymous with fractures. The terms only mean that your bone density has been compromised, and a fracture is more likely to occur.

What Does the Loss of Bone Density Look Like?

You can’t think of bone as a monolithic, rock-like structure. It is a living and mutable collection of cells. Bone takes on a honeycomb shape in a very tight formation when we are young. As we start to lose bone density, the gaps within the honeycomb get larger and larger. As a result, this makes the bone weaker and more brittle, and osteopenia and osteoporosis are often the result.

The Causes of Abnormal Bone Density Loss

As mentioned before, there are several factors for bone density loss, and the simple fact is that for most, this begins as “normal.” We cannot control some risk factors, including gender — females are more likely to experience osteopenia and osteoporosis than males. Also, certain races, such as white and Asian, are more likely to experience bone density loss than Hispanic and black populations. Even family history and genetics play a role, and this is actively being studied to understand more. Age-related hormone changes like drops in estrogen in women and testosterone in men due to menopause and aging are among the most common causes.

However, many of the causes revolve around modifiable factors. These are factors within our control. These can include a history of a low Vitamin D and Calcium diet, smoking, and the use of specific medication. Certain steroids, long-term PPI or proton pump inhibitors, certain cancer drugs, some anxiety and depression medications, and certain type-two diabetes medications can all contribute to bone deterioration.

Diagnosing Bone Density Issues

Osteopenia and osteoporosis are considered silent conditions in that they do not have many outward symptoms, especially early on. A diagnosis of abnormally low bone density will have to start with a visit to your primary care physician. Having understood your lifestyle factors and dietary exercise habits, your PCP can develop a risk profile. From there, if bone degeneration is suspected, undergoing a quick, painless, and non-invasive procedure known as a DEXA scan is very common.

The DEXA scan is essentially two low-dose X-ray beams aimed at the bone, making it far more effective than a regular x-ray. Further, it is safe. New DEXA scans use only the same amount of radiation your body would absorb from two days of background radiation. This is significantly less than a regular x-ray.

DEXA can detect minimal changes in density loss, as small as 1%. This accuracy is why the procedure is the gold standard for bone density detection. The patient will be placed on a comfortable bed-like diagnostic table during the procedure. An open x-ray machine will then take a scan. Based on how the radiation is absorbed by the bone and soft tissue in the area, your radiologist and primary care physician can determine the bone density compared to others your age. This is known as the T-score. Most simply put, the lower your T-score, the weaker your bones. A score above -.01 is considered normal and in the healthy range. A score of -.01 to -.25 indicates osteopenia, while anything below -.25 is considered osteoporosis.


At a certain age, our bodies simply stop building enough new bone structure, and as such, there is no treatment for osteoporosis. Instead, we look to prevent further degeneration, falls, and other trauma that may lead to a fracture. Patients will be prescribed a diet high in Vitamin D and Calcium, both required for healthy and strong bones. Exercise will also be a significant part of the treatment process, as this strengthens the muscles leading to better balance, a lower risk of falling, and less pressure on the joints. At this time, most patients will be asked to moderate their alcohol consumption and eliminate smoking.

Medication can be used to treat osteoporosis but not usually for the treatment of osteopenia. As with most medications, there are side effects to be considered. Your physician will review your personal history to determine if medication is right for you at an earlier stage.

Preventing Fractures Is the Goal

Osteopenia is not often connected with fracturing and is essentially the “warning shot” that steps should be taken to improve diet, exercise, and eliminate factors within our control. Medication may be avoided until other changes no longer slow the progression of bone loss. And because some insurance companies don’t recognize osteopenia as a full disease, some may not cover the cost of medications.

The medications most prescribed for osteoporosis are Bisphosphonates. Bisphosphonates are designed to slow the rate of bone loss and often include: Alendronate or Fosamax; Risedronate or Actonel; Ibandronate or Boniva; and Zoledronic Acid or Reclast, which is an annual intravenous infusion. For those with reduced kidney function and for whom bisphosphates aren’t an option, there is Denosuman or Prolia/Xgeva.

Prevention of Osteopenia

Prevention of osteopenia and osteoporosis starts early in life when our bones still have the capability to regenerate. Educating younger patients on the importance of a proper diet, including maintaining a normal weight — not too high and not too low — is critical. Further, if necessary, a balanced diet and dietary supplementation are important to maintain proper Calcium and Vitamin D levels. Exercise should be pursued throughout life to ensure healthy bone health and proper weight, not to mention improved stability.

As we’ve said before, osteoporosis is not a guarantee of experiencing fractures. However, it does make a fracture much more likely. The prognosis for patients with mild to moderate osteoporosis is excellent if they seek appropriate treatment and follow their doctor’s treatment plan. The outcomes may be somewhat less favorable for those that allow osteoporosis to progress. The prognosis for osteoporosis improves the earlier the disease is found and treated.

Take The Next Steps

Treatment or prevention of osteopenia and osteoporosis begins with a visit to a qualified specialist such as those at Florida Medical Clinic Orlando Health. We welcome patients who are at risk of these conditions or who have been diagnosed to visit us at our Land O’ Lakes, Seminole Heights or Zephyrhills offices to learn more. The fracture risk of associated with osteoporosis can be mitigated, and FMC is there to help you do just that!

About Julie Norton, APRN – Rheumatology

Julie Norton received her Bachelor of Science Degree in Nursing at Barry University, Miami Florida in 1996. She is certified in Clinical Densitometry and her primary focus for the past 5 years has been Bone Health, prevention and treatment of Osteoporosis.

Disclaimer: This blog is not intended to substitute professional medical advice. Every patient is different, so talk with your doctor to learn what treatment options are best for you.



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