Osteopenia: Key Aspects to Know

Introduction – Osteopenia Care in Montgomery County, Maryland

As an osteoporosis specialist practicing in Montgomery County, Maryland, I specialize in providing tailored care to individuals experiencing hormone imbalances that can result in osteopenia or osteoporosis. I employ a comprehensive, evidence-based approach to address my patients’ unique needs and conditions.

Conveniently located in Rockville, my practice offers virtual and in-person services, extending support to nearby areas such as Chevy Chase, Bethesda, North Bethesda, Potomac, North Potomac, Gaithersburg, Germantown, Frederick, Silver Spring, Northern Virginia, Howard County, Anne Arundel, and the Eastern Shore of Maryland, ensuring comprehensive care.

Without further ado, let’s explore the key aspects of osteopenia, including risk factors, diagnosis, prevention, and treatment, among others.

1. What is Osteopenia?

Osteopenia is a condition where bone mineral density (BMD) is lower than normal but not low enough to be classified as osteoporosis. It is a precursor to osteoporosis and indicates that bones are weaker than they should be, making them more susceptible to fractures. Understanding osteopenia is key for early intervention and prevention of more severe bone density loss. 

In the USA, approximately 47 million people have osteopenia, affecting about half of those over 50. Globally, around 40% of people have osteopenia, highlighting its prevalence and the need for increased awareness and management worldwide.

Osteopenia is technically characterized by a reduction in BMD, a measure of the amount of minerals (such as calcium) in a specific volume of bone. This condition suggests that bone loss is occurring, but it has not yet reached the severity of osteoporosis. The World Health Organization (WHO) defines osteopenia as a BMD T-score between -1.0 and -2.5. A T-score compares an individual’s bone density with that of a healthy 30-year-old of the same sex.

2. Causes of Osteopenia

Several factors contribute to the development of osteopenia, including:

  • Age: As people age, bone density naturally decreases.
  • Genetics: A family history of low bone density can increase the risk.
  • Hormonal Changes: Women, particularly postmenopausal women, are at higher risk due to decreased estrogen levels, which protect bone density.
  • Nutritional Deficiencies: Lack of calcium and vitamin D can lead to weaker bones.
  • Lifestyle Choices: Smoking, excessive alcohol consumption, and a sedentary lifestyle contribute to bone loss.
  • Medical Conditions: Diseases such as hyperthyroidism, rheumatoid arthritis, and celiac disease can affect bone density.
  • Medications: Long-term use of corticosteroids and other medications can decrease bone density.

3. Symptoms and Diagnosis

Osteopenia often has no symptoms. It is usually detected through screening methods, primarily a dual-energy X-ray absorptiometry (DEXA) scan, which measures BMD. Routine screenings are recommended for:

  • Women aged 65 and older
  • Postmenopausal women under 65 with risk factors
  • Men aged 70 and older
  • Men aged 50-69 with risk factors

4. Risk Factors

Understanding the risk factors is essential for early detection and prevention. Key risk factors include:

  • Age: Increased age is a primary risk factor.
  • Sex: Women are more prone to bone density loss.
  • Family History: A genetic predisposition to low BMD.
  • Body Frame Size: Small, thin individuals have less bone mass.
  • Hormone Levels: Low estrogen or testosterone levels.
  • Diet and Lifestyle: Poor nutrition, lack of exercise, and unhealthy habits.

5. Prevention

Preventing osteopenia involves maintaining bone density through various strategies:

Diet: Ensure adequate intake of calcium and vitamin D. Dairy products, leafy greens, and fortified foods are good sources.

Exercise: Weight-bearing and resistance exercises strengthen bones.

Lifestyle Changes: Avoid smoking and limit alcohol consumption.

Medical Management: Address underlying medical conditions and review medications with your endocrinologist.

6. Treatment

The primary goal of treating osteopenia is to prevent further bone loss and progression to osteoporosis. Treatment options include:

  • Dietary Supplements: Calcium and vitamin D supplements are often recommended.
  • Exercise: Regular physical activity is crucial. Focus on weight-bearing and muscle-strengthening exercises.
  • Lifestyle Modifications: Adopting an overall healthy lifestyle, including refraining from smoking and moderating alcohol intake
  • Medications: Bisphosphonates, selective estrogen receptor modulators (SERMs), and hormone or testosterone replacement therapy (HRT, TRT) may be prescribed.

7. Impact on Quality of Life

Osteopenia can affect quality of life, particularly if it progresses to osteoporosis. Potential impacts include:

  • Increased Fracture Risk: Even minor falls can lead to fractures, particularly in the hip, spine, and wrist.
  • Mobility Issues: Fractures can lead to reduced mobility and independence.
  • Chronic Pain: Bone fractures, especially in the spine, can cause long-term pain.
  • Emotional Health: The fear of falling and sustaining fractures can lead to anxiety and depression.

8. Monitoring and Follow-up

Regular monitoring of bone density is essential for individuals diagnosed with osteopenia. Follow-up DEXA scans help assess the effectiveness of treatment and lifestyle changes. Endocrinologists may recommend:

  • Regular Screenings: Based on initial results and risk factors, follow-up intervals may vary.
  • Monitoring Medication Effects: If medications are prescribed, monitoring their effectiveness and side effects is important.
  • Adjusting Treatment Plans: Treatment plans should be adjusted based on follow-up results and changing health conditions.


Osteopenia is a critical condition that serves as a warning sign for potential osteoporosis. Early detection through screening, understanding risk factors, and implementing preventive measures are vital in managing osteopenia. A holistic approach involving diet, exercise, lifestyle changes, and medical management can significantly impact bone health and quality of life. Regular monitoring and collaboration with an endocrinologist ensures that individuals with osteopenia can maintain strong bones and reduce the risk of fractures, leading to a healthier, more active life.

Dr. Tashko

Dr. Tashko is an ABIM board-certified endocrinologist with additional certifications in lipidology, hypertension, and obesity medicine. He delivers personalized, holistic care to patients in Montgomery County, Maryland.