Osteopenia: Know Your Fracture Risk

Osteopenia, an early stage of bone loss, isn't as serious as osteoporosis, but it can still cause your bones to break. Are you at risk?

By Diana Rodriguez

Medically reviewed by Lindsey Marcellin, MD, MPH

Do you know your T-score? This magic little number is calculated from bone density tests such as dual absorption absorptiometry (DEXA) — and it can tell you a lot about yourbone health. If your score shows low bone density (but not yet low enough to be osteoporosis), you could have osteopenia.

But to get a full picture of your bone health, you and your doctor need to take several additional factors into account.

Bone Density Tests: Your T-Score

Your T-score is a number on a scale that measures bone density. The ideal score is 0, which means that your bones are as dense as those of a healthy young adult. Negative numbers indicate less-dense bone. The lower the number, the more severe the bone loss; for example, -3 is worse than -2.

A T-score between +1 and -1 is considered normal. Osteoporosis is defined as a T-score lower than -2.5, which indicates substantial bone loss and significant risk of fractures. A T-score between -1 and -2.5 indicates less-severe bone loss, a condition called osteopenia.

However, even with a T-score in the osteopenia range, you can still be at risk of fracturing a bone. In fact, more than 50 percent of fractures due to weakened bones occur in women with T-scores in this range.

Assessing Other Fracture Risk Factors

Your T-score is only one piece of the puzzle. Determining your fracture risk requires also looking at your current health, medical history, and other factors. Your risk of breaking a bone is higher if you:

• Are 65 years old or older
• Have a thin, small frame
• Smoke tobacco
• Experienced early menopause
• Have a family history of osteoporosis
• Have used steroids for a long time or used certain anti-seizure medications
• Are undergoing treatment for prostate cancer or breast cancer
• Have an overactive thyroid or are taking high doses of thyroid hormone for an underactive thyroid
• Are female — men also experience bone loss as they age but are less likely to develop osteoporosis or experience fractures
• Don’t get enough calcium and vitamin D
• Consume more than three alcoholic drinks per day
• Have a disease that can cause bone loss, such as rheumatoid arthritis or anorexia nervosa

Evaluating Your Risk

One way to calculate your fracture risk based on the above factors is to use the WHO Fracture Risk Assessment Tool, or FRAX, according to Nelson Watts, MD, a nationally recognized bone health and osteoporosis expert and the director of the Osteoporosis and Bone Health Program at the University of Cincinnati in Ohio.

Available for free online, the FRAX calculator, which was developed by the World Health Organization (WHO), uses a range of criteria to determine your likelihood of having a fracture in the next 10 years. FRAX is an effective assessment of risk because it incorporates so many factors, says Dr. Watts.

Guidelines from the National Osteoporosis Foundation encourage the use of FRAX for patients with T-scores between -1 and -2.5, says Watts. For people with scores in this range, the foundation recommends osteoporosis medication for those who also have a FRAX 10-year probability of a hip fracture of 3 percent or higher or a FRAX 10-year probability of a major osteoporosis-related fracture of 20 percent or higher.

Having a bone density test to learn your T-score is important for those concerned about bone health and fracture risk. But remember that your T-score alone doesn't give you a complete appraisal of your risk of breaking a bone. For a more realistic assessment, take a look at the bigger picture.