Osteopenia: What It Is and How to Treat It

You’ve probably heard of osteoporosis, which refers to bone loss that can leave you more vulnerable to fractures. But osteoporosis doesn’t happen overnight; instead, bones get a little thinner over the years as you age. Osteopenia is what comes just before osteoporosis. If you have osteopenia, it means your bone density is lower than normal, but not yet low enough to be classified as osteoporosis.

“Think of it like a stop-light rating system,” says Kristin Vinci, PT, DPT, a physical therapist at Hinge Health. “If green is good bone health and red is osteoporosis, then yellow is osteopenia.”

Read on to learn more about osteopenia and how to keep your bones strong with help from our Hinge Health physical therapists.

What Is Osteopenia?

Osteopenia is considered a precursor to osteoporosis. Like osteoporosis, osteopenia is characterized by a loss of bone mass. 

Did you know that the insides of your bones look more like a honeycomb than a solid white mass? In the case of osteopenia, the spaces in this “honeycomb” become larger, indicating less bone density. This makes bones more susceptible to fractures (breaks). This borderline “condition” should serve as a warning sign, but many people don’t know that they have it because there aren’t any symptoms.

One way to be officially diagnosed with osteopenia (or osteoporosis) is to have a bone mineral density scan (DEXA scan). This test measures the density of your bones, and it yields a score called a T-score. A score of -2.5 or lower means you have osteoporosis. If you fall in the middle, between -1 to -2.5, you have osteopenia.

Not everyone develops osteopenia, but it’s incredibly common. About 18 million Americans have it, according to the National Council on Aging. Women ages 65 or older should have a bone density test, as should some women who are younger but postmenopausal as changes in hormone levels can affect bone mass. Some men may need this test, too, so check with your doctor. If your doctor doesn’t think you need this test yet (or at all), that doesn’t mean you’re in the clear: Many people who haven’t been tested have osteopenia, which, left untreated, can pave the way for osteoporosis.

Causes of Osteopenia

There are many reasons why your bones might be thinner than they should be. Some risk factors are modifiable, while others aren’t, but that doesn’t mean you’re doomed, says Dr. Vinci. If you know you’re at increased risk, focus on changing the things that are in your control, so you can help slow, prevent, or reverse osteopenia.

Common factors that increase the risk of osteopenia include:

• Age and biological sex. Osteopenia most often occurs in people over 50, especially women who have gone through menopause. During menopause, estrogen, which helps protect bones, drops to very low levels.

• Genetics. Your peak bone mass (the strongest it will ever be) is influenced significantly by your genes, as is your predisposition to osteopenia and osteoporosis. If you know you’re susceptible — perhaps your mother or grandmother had it — it’s especially important to be proactive about nutrition and exercise.

• Smoking status. Smokers and former-smokers have a higher risk of osteopenia and osteoporosis because nicotine slows the production of the cells that make new bone.

• Certain medications. Many common medications can take a toll on your bones. They include blood thinners like heparin, some diuretics, certain cancer drugs, and glucocorticoids used by many people with inflammatory and autoimmune diseases.

• Lack of calcium and vitamin D. Both are essential for strong bones, and if you don’t get enough of these nutrients, deficiencies may contribute to osteopenia.

• Too much alcohol or caffeine. Research on alcohol and bone health has been mixed, but at least one large study found a significant correlation between drinking and osteoporosis. The more alcohol you consume, the higher the risk — but even two drinks per day might be problematic. Research on caffeine has been similarly mixed, but science suggests too much may promote bone loss.

• Activity level. “Bones constantly respond to load or lack of load,” says Dr. Vinci. “Just as your muscles will atrophy if you don’t work them, your bones will become weaker with lack of exercise.”

Symptoms of Osteopenia

Osteoporosis is often called a “silent” disease because it rarely causes noticeable symptoms until you suffer a fracture. As the precursor to osteoporosis, osteopenia is even less likely to grab your attention, but there are a few warning signs, like height loss or a more stooped posture.

Even if you don’t have any signs, protecting your bone health is something everyone should do to help support a strong, healthy body in order to delay or prevent osteopenia or osteoporosis. 

How to Prevent and Treat Osteopenia

There are many things you can do to reduce your risk of osteopenia or fight back if you already have it, says Dr. Vinci. Strategies include:

• Get enough calcium and vitamin D. It’s best to obtain these nutrients from food instead of pills, if possible. Most people should aim for three to four servings of calcium-rich foods per day, such as low-fat dairy, canned salmon (or other fish with bones), and darky, leafy greens like kale and collard greens. Some foods are fortified with vitamin D, but it can be harder to get enough from food; ask your doctor if you should take a supplement.

• Quit smoking. If you’re a smoker, it’s important to seek out resources to help you scale back or quit because smoking can increase your risk for osteopenia. 

• Limit alcohol and caffeine. Although the research isn’t conclusive, too much may put you at risk of osteopenia (as well as other health problems).

• Review your medications with your doctor. Find out if any meds you’re taking increase the risk of osteopenia and osteoporosis. If so, and you need to continue taking them, ask what you can do to counteract the side effects. You may benefit from supplemental calcium and vitamin D.

• Move more. Staying as active as possible can help a lot, says Dr. Vinci.Moving more may seem like it would put extra stress on bones, but bones actually get stronger when challenged. Weight-bearing exercise, which means you’re moving while standing and working against gravity, is great for bone health. Walking, jogging, dancing, and tennis are all good picks, as are many other cardio activities. Resistance training is also important for strong bones. “You can hold weights, carry heavy items, or work with resistance bands,” says Dr. Vinci.

These resistance moves from our Hinge Health physical therapists will help you strengthen your bones as well as the muscles that support them in order to help you get stronger and reduce your risk of developing osteopenia.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Jump to Build Strong Bones 

If you have osteopenia but not full-on osteoporosis, jumping exercises — like jumping jacks or jumping rope — might be worth incorporating into your routine, says Dr. Vinci. In fact, research has shown that jumping just 10 or 20 times a day can increase bone density in premenopausal women. If you’re older or have severe osteoporosis, however, stick to other weight-bearing exercises (as well as resistance and cardio moves), says Dr. Vinci. “If you already have significant bone loss, adding high impact activities too quickly can put you at risk for fractures,” she explains. “Check with your doctor or physical therapist on how to get started safely."

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Osteoporosis. (2017, April 7). National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/osteoporosis 

2. Varacallo, M., Seaman, T. J., Jandu, J. S., & Pizzutillo, P. (2020). Osteopenia. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499878/ 

3. What Is Osteopenia and How Does it Affect Older Adults? (2023, August 10). The National Council on Aging. https://www.ncoa.org/article/what-is-osteopenia-and-how-does-it-affect-older-adults 

4. Bone Mineral Density Tests: What the Numbers Mean. (2023, May 5). National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/bone-mineral-density-tests-what-numbers-mean 

5. Osteopenia (Low Bone Density): What Is It, Prevention, Symptoms, Causes & Treatment. (2021, September 29). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21855-osteopenia 

6. Ralston, S. H. (2007). Genetics of osteoporosis. The Proceedings of the Nutrition Society, 66(2), 158–165. doi:10.1017/S002966510700540X

7. Smoking and Musculoskeletal Health. (2021, September). OrthoInfo - AAOS. https://orthoinfo.aaos.org/en/staying-healthy/smoking-and-musculoskeletal-health 

8. Rosen, H. N. (2024, April 6). Drugs that affect bone metabolism. UpToDate. https://www.uptodate.com/contents/drugs-that-affect-bone-metabolism 

9. Osteoporosis Diet & Nutrition: Foods for Bone Health. (2023). Bone Health & Osteoporosis Foundation. https://www.bonehealthandosteoporosis.org/patients/treatment/nutrition/ 

10. Berg, K. M., Kunins, H. V., Jackson, J. L., Nahvi, S., Chaudhry, A., Harris, K. A., Malik, R., & Arnsten, J. H. (2008). Association Between Alcohol Consumption and Both Osteoporotic Fracture and Bone Density. The American Journal of Medicine, 121(5), 406–418. doi:10.1016/j.amjmed.2007.12.012

11. Berman, N. K., Honig, S., Cronstein, B. N., & Pillinger, M. H. (2022). The effects of caffeine on bone mineral density and fracture risk. Osteoporosis International, 33(6), 1235–1241. doi:10.1007/s00198-021-05972-w

12. Tucker, L. A., Strong, J. E., LeCheminant, J. D., & Bailey, B. W. (2015). Effect of Two Jumping Programs on Hip Bone Mineral Density in Premenopausal Women: A Randomized Controlled Trial. American Journal of Health Promotion, 29(3), 158–164. doi:10.4278/ajhp.130430-quan-200

13. Campbell, B. J. (2020, July). Exercise and Bone Health. OrthoInfo - AAOS. https://orthoinfo.aaos.org/en/staying-healthy/exercise-and-bone-health/ 

14. Korducki, J. (2023, March 8). Osteoporosis: The Silent Disease. Mayo Clinic Health System. https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/osteoporosis-silent-disease