Bone Health After 50: Osteopenia vs Osteoporosis and DEXA

A bone density test, usually a central DXA (DEXA) scan of the hip and lower spine, reports a T-score for postmenopausal women and men 50 and older: how your bone density compares with a healthy young adult (NIAMS).

NIAMS notes that fracture risk rises 1.5 to 2 times with each 1-point drop in T-score. Premenopausal women and men under 50 get a Z-score instead, which compares them with people of the same age, ethnicity and sex.

Osteopenia is a measurement, not a sentence. The USPSTF notes that most fragility fractures happen in people whose T-score is above the osteoporosis cutoff, which is why clinicians combine the scan with a fracture-risk assessment (USPSTF 2025).

The US Preventive Services Task Force’s January 14, 2025 recommendation (USPSTF; PMID: 39808425):

Risk factors the Task Force lists include low body weight, a parent who broke a hip, smoking and excess alcohol. On repeat scans, it notes that cohort studies found repeating a scan at 4 to 8 years did not improve fracture prediction, and that time to osteoporosis is shorter for people with lower starting T-scores and older age. Your clinician sets the interval.

NIAMS lists the pillars as nutrition, lifestyle changes, exercise, fall prevention and, when needed, medicines (NIAMS: Osteoporosis treatment).

Calcium and vitamin D, ideally from food. NIH recommended daily amounts: calcium 1,200 mg for women 51–70, 1,000 mg for men 51–70 and 1,200 mg for everyone 71 and older (NIH ODS: Calcium); vitamin D 600 IU through age 70 and 800 IU from 71 (NIH ODS: Vitamin D). WHI investigators conclude that routine calcium-plus-vitamin-D pills are not supported for preventing fractures in all postmenopausal women, but are appropriate for women who don’t get enough from their diet (PMID: 38691368). Evidence: B (one large randomized trial).

Strength training. NIAMS says strength or resistance training is the best activity for bone health. In older adults, exercise mainly builds muscle, strength and balance, which lowers fall risk, rather than adding bone mass. In the LIFTMOR trial, 101 postmenopausal women (average age 65) with low bone mass did 8 months of twice-weekly, closely supervised high-intensity resistance and impact training; lumbar spine density rose 2.9% versus a 1.2% fall with low-intensity home exercise (Watson et al., J Bone Miner Res 2018; PMID: 28975661). Evidence: B (one randomized trial). NIAMS advises people with osteoporosis to avoid high-impact exercise, so get a supervised program rather than copying a trial on your own.

Fall prevention, alcohol and smoking. NIAMS advises no more than one drink a day for women and two for men, quitting smoking, and asking your doctor about medicines or conditions that raise fall risk.

NIAMS lists these FDA-approved classes for osteoporosis: bisphosphonates; a RANK ligand inhibitor; parathyroid hormone and PTH-related protein analogs; a sclerostin inhibitor; estrogen agonist/antagonists (SERMs) and a tissue-selective estrogen complex; calcitonin; and estrogen or hormone therapy. Each has its own benefits, side effects and duration rules, so the choice depends on your fracture risk and history.

For women near menopause, hormone therapy prevents bone loss and fracture (NAMS 2022; PMID: 35797481); see perimenopause and HRT.

Rapid or large weight loss can cost bone as well as muscle, with greater losses at older ages and in women, according to the 2025 GLP-1 nutrition advisory (PMID: 40450457). Evidence: C (expert advisory summary). If you are losing weight on a GLP-1 after 50, ask whether a bone-density check makes sense, keep calcium, vitamin D and protein up, and lift. See eating on a GLP-1 and protecting muscle on a GLP-1.