Osteopenia is a condition characterized by decreased bone mineral density that is below normal levels but not low enough to be classified as osteoporosis, which leads to increased fracture risk. It affects both men and women, with a global prevalence of approximately 40.4%, and postmenopausal women are particularly at risk due to lower estrogen levels.

Osteopenia typically does not cause any symptoms, and it often goes unrecognized. The first noticeable sign may be a fragility fracture, which occurs from an impact that would not normally cause a fracture in a person without osteopenia.

Osteopenia is diagnosed by measuring bone mineral density using a DXA scan, and a T-score between −1 and −2.5 indicates the condition. Additional blood tests may be conducted to evaluate levels of calcium, phosphorus, vitamin D, and other hormones to identify potential underlying issues.

The main medical treatments for osteopenia focus on prevention of fractures and include lifestyle modifications such as regular weight-bearing exercise, adequate calcium and vitamin D intake, avoiding smoking and excessive alcohol, addressing underlying health issues, and practicing fall prevention strategies. These measures aim to slow or stop the progression to osteoporosis.

Calcium and vitamin D are essential for bone health, and supplementation is recommended if dietary intake is insufficient. Other supplements (like vitamin K, soy isoflavones, magnesium, and creatine) show potential benefits for osteopenia, but further research is needed to confirm their effectiveness.

Diet significantly affects bone health, and Western dietary patterns are associated with increased risks of low bone mineral density (BMD) and fractures, whereas healthier diets like the Mediterranean diet and diets that are rich in dairy are associated with reduced risks. Adequate nutrient intake, particularly of calcium, is crucial for achieving peak bone mass and minimizing age-related declines in BMD.

Medications for osteopenia are typically prescribed for people who are at high risk of fractures, particularly those with a T-score between −1 and −2.5 and a 10-year fracture risk of 20% or more. Bisphosphonates are the most common treatment, and other options include hormone-replacement therapies, selective estrogen receptor modulators, calcitonin, teriparatide, and denosumab; prolonged use of bisphosphonates is limited to 3 to 5 years due to potential risks.

Osteopenia is caused by a natural loss of bone mass that begins after age 30; when bone breakdown exceeds bone building, it leads to reduced bone density. Factors that influence this process include genetics, physical activity, body mass, nutrition, hormones, certain diseases, medications, and lifestyle choices.