Osteopenia
Osteopenia -- bone mineral density (BMD) between 1.0 and 2.5 standard deviations below the young adult mean (T-score −1.0 to −2.5) -- represents a transitional state between normal bone density and osteoporosis. Not all osteopenia requires medication, but it warrants calcium and vitamin D management, fall risk reduction, and regular monitoring to detect progression.
Symptoms
Osteopenia itself causes no symptoms. The concern is for fracture risk -- low-energy fractures of the wrist, hip, or spine may occur with more force than in osteoporosis but less force than in normal-density bone. Back pain may develop with vertebral fractures.
Causes and risk
Peak bone mass at age 30 and subsequent rate of loss determine who develops osteopenia. Risk factors include female sex, estrogen deficiency (early menopause, PCOS), low body weight, family history, corticosteroid use, calcium and vitamin D deficiency, smoking, excessive alcohol, sedentary lifestyle, and secondary causes (celiac disease, inflammatory bowel disease, rheumatoid arthritis).
How it is evaluated
DEXA scan of the spine and hip is the standard measurement. The FRAX tool calculates 10-year major and hip fracture probability using BMD and clinical risk factors. We assess secondary causes: 25-hydroxyvitamin D, PTH, calcium, phosphorus, thyroid function, and when indicated, bone turnover markers and celiac antibodies.
Treatment
Lifestyle measures: calcium 1,000 -- 1,200 mg/day from diet and supplements, vitamin D 1,500 -- 2,000 IU/day targeting serum 25-OH-D above 30 ng/mL, weight-bearing and resistance exercise, fall prevention. Bisphosphonate or other anti-resorptive medication is reserved for high FRAX scores or additional risk factors. DEXA is repeated every 1 -- 2 years.