While osteopenia and osteoporosis have similar names, and both relate to bone loss and weakness, they are not exactly the same.

If you have low bone mass (low bone mineral density) compared with the norm — but it’s not low enough to be considered osteoporosis — your doctor may tell you that you have osteopenia.

Like osteoporosis, osteopenia raises your risk of a bone fracture, because the more porous your bones are, the more likely they are to break. But because people with osteopenia have higher bone mineral density than those with osteoporosis, the risk of a fracture is lower for individuals with osteopenia.

Osteopenia increases your risk of developing osteoporosis and is considered a precursor to it.

But not everyone with osteopenia will go on to develop osteoporosis, and changes in diet and lifestyle may help to prevent crossing the line from osteopenia to osteoporosis.

Neither osteopenia, nor the early stages of osteoporosis, typically cause any symptoms. But if you have risk factors for osteoporosis, or you experience a bone fracture, your doctor may advise you have a bone density scan.

Your doctor will most likely determine your bone mineral density with a noninvasive test called dual-energy X-ray absorptiometry (DXA or DEXA). This test uses X-rays to measure bone density in the hip, spine, and sometimes other bones.

DXA results are given in what’s called T-scores that help to determine which category — osteopenia, osteoporosis, or normal — you fall into:

• A T-score higher than -1 means you have normal bone density.
• A T-score between -1 and -2.5 means you have osteopenia.
• A T-score lower than -2.5 indicates osteoporosis. (1)

The lower the T-score, the weaker your bones.

In the United States, approximately 10 million adults have osteoporosis, while another 44 million have low bone density that puts them at risk for osteoporosis. (2,3)

Like osteoporosis, osteopenia affects older white women in the greatest numbers. But anyone can develop osteopenia, including men. Consider this: About a third of white and Asian men over age 50 are affected, and osteopenia also affects 23 percent of Hispanic men and 19 percent of black men. (1)

Although people with osteoporosis have a much higher risk of bone fractures than those with osteopenia, the majority of osteoporotic bone fractures occur in people with T-scores in the osteopenia range.

This is because significantly more people have osteopenia than osteoporosis, according to 2012 report in Reviews in Endocrine & Metabolic Disorders. (4)

Your bone density peaks around age 30, then slowly begins to decline as your body breaks down old bone faster than it forms new bone.

Your bones will become weaker and thinner if too much calcium is withdrawn from them, leading to osteopenia or osteoporosis.

Some bone loss with aging is natural and expected, but numerous factors can affect the rate of loss.

Factors known to increase the rate of bone loss, leading to osteopenia and osteoporosis, include the following.

Osteopenia risk factors you can’t control include:

• Being female
• Going through early menopause
• Being at least 50 years old
• Having naturally small, thin bones
• Being Caucasian or Asian
• Having a family history of bone disease

Osteopenia risk factors you can control include:

• Smoking
• Drinking alcohol in excess
• Having dietary deficiencies in calcium and vitamin D
• Leading an inactive or sedentary lifestyle
• Taking certain types of medication for a long time, including glucocorticoids and some anticonvulsants

Underlying conditions that raise your risk of osteopenia include:

• Having anorexia, rheumatoid arthritis, or another disease that can cause bone loss
• Having low levels of estrogen (in women) or low testosterone (in men)

Various lifestyle changes may help treat osteopenia, including:

• Getting recommended amounts of calcium and vitamin D in your diet
• Quitting smoking
• Limiting alcohol intake
• Exercising every day
• Following a nutrition-rich diet

Medication may also be an option for treating osteopenia, but many doctors are cautious about prescribing drugs for the condition, since your fracture risk with osteopenia is low, and medication may not reduce your risk by much. Additionally, more research is needed to assess the long-term benefits and risks of using medication to treat osteopenia. (1,4)

If your T-score is under -2, your doctor may recommend lifestyle changes to improve your bone health.

If your T-score is close to -2.5 — or close to the osteoporosis range — it is possible your doctor may consider putting you on medication to keep your bones stronger and reduce the risk of fractures. Potential drugs include those used to treat osteoporosis:

• Bisphosphonates, such as Fosamax (alendronate), Boniva (ibandronate), Actonel (risedronic acid), and Reclast (zoledronic acid), which inhibit bone resorption
• Forteo (teriparatide), a synthetic form of a hormone that stimulates bone formation
• Selective estrogen-receptor modulators such as Evista (raloxifene), which have positive estrogen-like effects on the bones
• Calcitonin, which has been shown to increase bone mineral density

Even if you decide to use medication, lifestyle measures, such as engaging in weight-bearing exercise and following a healthy diet, are still important.