Osteopenia vs Osteoporosis: T-Scores and Fracture Risk
Medically reviewed by Dr. Michael Teplitsky, MD Last reviewed 2026-10-27
Bone mineral density scans assign categories, while total fracture risk informs medical care
For postmenopausal women and men age 50 and older, the Bone Health and Osteoporosis Foundation calls a T-score between -1.0 and -2.5 osteopenia and -2.5 or below osteoporosis. At The Metabolic Journal, we compare what the Bone Health and Osteoporosis Foundation, MedlinePlus, and one Manitoba cohort study report. Both labels come from the same bone density scan results. According to MedlinePlus, the score helps predict fracture risk, and treatment recommendations depend on total fracture risk, which can be calculated with the FRAX score. Bone mineral density testing does not diagnose fractures.
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For postmenopausal women and men age 50 and older, the Bone Health and Osteoporosis Foundation defines normal bone density, low bone mass, and osteoporosis.
| Category | BHOF T-Score Range (Postmenopausal Women and Men Age 50+) | MedlinePlus T-Score Range |
|---|---|---|
| Normal bone density | -1.0 or above | -1.0 or above |
| Osteopenia (low bone mass) | Between -1.0 and -2.5 | -1.1 to -2.4 (may have bone loss) |
| Osteoporosis | -2.5 or below | Equal to or below -2.5 (likely osteoporosis) |
MedlinePlus says a negative T-score means thinner bones than the comparison group, and the more negative the number, the higher the risk of a bone fracture. Our bone density T-score page covers that topic.
How a Bone Density Scan Reports T-Scores and Z-Scores
A bone mineral density test measures the amount of calcium and other minerals inside a specific section of bone. MedlinePlus notes that dual-energy x-ray absorptiometry, commonly called a DEXA scan, is the most common and accurate method. Our DEXA scan page covers that topic. The test is painless.
Results are usually reported as a T-score and a Z-score. The T-score compares an individual's bone mineral density with the density of a healthy young woman. The Z-score compares that density with other individuals of the same age, sex, and race. With either measurement, a negative value indicates bones that are thinner than the reference group. The more negative the number, the higher the risk of a bone fracture, MedlinePlus says.
Two types of scanning equipment perform these measurements. In a central DEXA scan, you lie on a soft table. The scanner passes over your lower spine and hip, and in most cases, you do not need to undress. MedlinePlus identifies central DEXA as the best test to predict fracture risk, especially of the hip.
Peripheral DEXA machines represent the second variety. These smaller units measure mineral density in the wrist, fingers, leg, or heel. They operate in locations such as some health care offices, pharmacies, shopping centers, and health fairs. MedlinePlus says to tell your provider if you are or could be pregnant, to skip calcium supplements for 24 hours before the test, and to remove metal items such as jewelry and buckles. MedlinePlus states that you must stay still during the scan.
MedlinePlus states that you receive more radiation from a chest x-ray than a DEXA scan. Most experts feel the radiation risk is very low compared with the benefit of finding osteoporosis before a bone breaks.
What the Label Does and Does Not Predict
MedlinePlus states that bone mineral density testing does not diagnose fractures. Along with other risk factors, it helps predict the risk of a future fracture. Treatment recommendations depend on total fracture risk, which can be calculated with the FRAX score.
In one Manitoba cohort studied by Cranney and colleagues, most fractures occurred in women with nonosteoporotic values. In that historical cohort (Canadian Medical Association Journal, 2007), researchers evaluated 16,505 women aged 50 or older in the Manitoba Bone Density Program. Over a mean observation period of 3.2 years, 765 incident fractures occurred. The mean age of the participants was 65 years, with a standard deviation of 9 years.
The mean T-scores across all measured skeletal sites in the Manitoba cohort fell within the osteopenic category. The overall fracture rate was 14.5 per 1,000 person-years. Fracture rates were higher in women age 65 and older than in women age 50 to 64, measuring 21.6 versus 8.6 per 1,000 person-years. Between 59.7% and 67.8% of all fractures occurred in nonosteoporotic participants, depending on the anatomical site measured.
The nonosteoporotic category in that Manitoba study included women with normal bone density and women with osteopenia combined. The study does not state that most fractures occurred specifically in osteopenia. The cited sources do not state whether osteopenia leads to osteoporosis. Our osteopenia page covers that condition. Our osteoporosis page covers that condition.
Who Is Tested for Bone Density
The Bone Health and Osteoporosis Foundation states that women age 65 and older should receive a bone mineral density test. It states that men age 70 and older should receive testing. Anyone who has broken a bone after age 50 also qualifies for a scan under its guidance.
BHOF also lists women age 50 to 64 with risk factors and men age 50 to 69 with risk factors. Those risk factors include family history, frequent falls, vitamin D deficiency, smoking, excessive alcohol intake, malabsorption, and medications such as prednisone.
MedlinePlus lists several additional risk factors that may prompt testing in younger women and men of any age. These include fracturing a bone after age 50 or having a strong family history of osteoporosis. Treatments for breast cancer or prostate cancer represent additional risk factors. Conditions including rheumatoid arthritis, diabetes, thyroid imbalances, or anorexia nervosa can prompt testing. Other factors include early menopause, long-term use of corticosteroids, thyroid hormone, or aromatase inhibitors, and low body weight under 127 pounds (57 kilograms). Additional factors include a body mass index under 20, significant loss of height, and long-term tobacco or excessive alcohol use.
Testing reasons extend beyond initial screening. MedlinePlus notes that tests are performed to detect bone loss, to evaluate how well osteoporosis medications are working, and to estimate the risk of future fractures. The US Preventive Services Task Force supports bone density testing for women age 65 and older and for select younger women who have an increased risk. MedlinePlus notes that agreement is incomplete regarding men. Some medical groups suggest testing men at age 70, whereas other groups conclude evidence remains insufficient to confirm whether men benefit from screening.
Where to Read Next
Our bone density T-score page and DEXA scan page cover those topics. Our how to reverse osteopenia guide covers that topic. Our exercises for bone density page and bone density after menopause page cover those topics. Our medications guide compares osteoporosis medications.
What Makes a Good Bone-Support Supplement
Get calcium from food first; if you supplement, calcium citrate absorbs better than carbonate and is gentler without a meal. Keep total calcium (food + pills) around 1,000–1,200 mg/day — more doesn't help bone. Pair it with vitamin D3 and K2, which help calcium reach bone, and split doses to ~500 mg for better absorption.
Frequently Asked Questions
What is the difference between osteopenia and osteoporosis?
For postmenopausal women and men age 50 and older, the Bone Health and Osteoporosis Foundation defines osteopenia as a T-score between -1.0 and -2.5. It defines osteoporosis as a T-score of -2.5 or below. Both labels come from the same bone density scan. MedlinePlus states that treatment recommendations depend on total fracture risk, which can be calculated with the FRAX score.
What T-score is osteopenia?
For postmenopausal women and men age 50 and older, the Bone Health and Osteoporosis Foundation defines osteopenia as a T-score between -1.0 and -2.5. MedlinePlus says that from -1.1 to -2.4, you may have bone loss (osteopenia).
Can you fracture a bone with osteopenia?
In a Manitoba cohort of 16,505 women aged 50 or older studied by Cranney and colleagues, most fractures occurred in women with nonosteoporotic T-scores (59.7% to 67.8% across measured sites). In that study, 'nonosteoporotic' includes women with normal and osteopenic results, so it does not say most fractures were in osteopenia. MedlinePlus reports that bone mineral density testing does not diagnose fractures. Treatment recommendations depend on total fracture risk, which can be calculated with the FRAX score.
Who should get a bone density test?
The Bone Health and Osteoporosis Foundation (BHOF) lists who should have a bone density test. It lists women age 65 and older and men age 70 and older. It also lists anyone who has broken a bone after age 50. It lists women age 50 to 64 with risk factors and men age 50 to 69 with risk factors. MedlinePlus adds that testing may be prompted in younger adults with risk factors such as significant loss of height, body weight under 127 pounds, or long-term corticosteroid use.
Does osteopenia lead to osteoporosis?
The named sources do not state whether osteopenia leads to osteoporosis. MedlinePlus notes that testing helps detect bone loss and predict the risk of future fractures. Our osteopenia page covers that condition.
What is a DEXA scan and is it safe?
A DEXA scan is a painless imaging test that measures calcium and other minerals in bone. Central DEXA scans the lower spine and hip. Peripheral DEXA scans the wrist, fingers, leg, or heel. MedlinePlus states that you receive more radiation from a chest x-ray than a DEXA scan. Most experts feel the radiation risk is very low compared with the benefit of finding osteoporosis before a bone breaks.
What is the difference between a T-score and a Z-score?
A T-score compares an individual's bone mineral density with the density of a healthy young woman. A Z-score compares that density with other people of the same age, sex, and race. With either score, a negative number indicates thinner bones than the comparison group.
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