Osteopenia
Osteopenia is bone density below normal but not low enough to meet the osteoporosis threshold -- a T-score between -1.0 and -2.5, per WHO/ISCD criteria.
Symptoms
No symptoms -- osteopenia is found on bone density testing, not felt.
Causes and risk
Age, menopause, low body weight, smoking, excess alcohol, and certain medications (long-term steroids especially) all lower bone density over time.
How it is evaluated
DEXA scanning is recommended for all women 65 and older, and younger postmenopausal women with elevated risk on a formal risk tool, per the 2025 USPSTF recommendation (evidence remains insufficient to recommend routine screening in men).
Treatment
Treatment is usually calcium, vitamin D, weight-bearing exercise, and monitoring -- medication is reserved for osteopenia plus a prior hip or spine fragility fracture, or FRAX-calculated risk above 20% (major fracture) or 3% (hip), per AACE/ACE guidance.
When to seek care
Osteopenia is not an emergency. A fracture from a minor fall at any point warrants prompt evaluation, since it may indicate the diagnosis needs updating to osteoporosis.