Osteopenia: The Precursor to Osteoporosis

Osteopenia is low bone mass (T-score -1.0 to -2.5) — **not a disease, but a risk state** for osteoporosis (T-score ≤ -2.5) and fracture.

Diagnosis (DXA Scan)

• Normal: T-score ≥ -1.0
• Osteopenia: -2.5 < T-score < -1.0
• Osteoporosis: T-score ≤ -2.5
• Severe osteoporosis: ≤ -2.5 + fragility fracture.

Risk Factors

• Age, female sex, menopause (estrogen loss), low BMI.
• Family history, prior fracture, smoking, excess alcohol.
• Glucocorticoids, PPIs, anticonvulsants, aromatase inhibitors.
• Secondary causes: Hyperthyroidism, hyperparathyroidism, celiac, IBD, CKD.

Management (FRAX® guides treatment)

• Lifestyle (all): Weight-bearing/resistance exercise 30 min/day; calcium 1000-1200 mg (diet + supplement); vitamin D 800-2000 IU; fall prevention; smoking cessation; limit alcohol.
• Pharmacotherapy if: FRAX 10-yr major osteoporotic fracture risk ≥20% or hip ≥3%; or T-score ≤ -2.0 with risk factors.
• Options: Bisphosphonates (alendronate), denosumab, anabolics (teriparatide, romosozumab) for high risk.

Monitoring

• DXA every 2-3 years (or 1 yr if on glucocorticoids).
• Bone turnover markers (CTX, P1NP) for treatment response.

Osteopenia is a **call to action**, not a sentence. Most fractures occur in osteopenic range (larger population). Early intervention preserves bone.