Osteopenia: What Your DEXA Scan Result Means and What to Do Next
If your DEXA scan result showed osteopenia, here is what that means and what to do about it.
Osteopenia means your bone density is lower than the normal range but has not yet reached the osteoporosis threshold. It is a useful measurement that gives you time and information to act.
Without management, bone density can continue to decline and progress to osteoporosis. Supervised exercise is the most effective tool for slowing that decline and, in many cases, improving your bone density.
What is a DEXA scan and what does the result mean?
A DEXA scan (Dual-energy X-ray Absorptiometry) measures bone mineral density which indicates how dense and strong your bones are. The result is expressed as a T-score, which compares your bone density to that of a healthy young adult. The classifications are:
| Classification | T-score |
|---|---|
| Normal | Greater than -1.0 |
| Osteopenia | -1.0 to -2.5 |
| Osteoporosis | -2.5 or below |
A T-score in the osteopenia range means your bone density is lower than expected and your fracture risk is slightly elevated compared to the normal range. Because it hasn’t yet reached the osteoporosis threshold, it offers an opportunity to act.
Who is most at risk of low bone density?
Several factors increase the likelihood of developing osteopenia or osteoporosis:
- Being over 50 years of age
- Post-menopausal women
- Family history of osteoporosis or fractures
- Inadequate calcium intake
- Vitamin D deficiency
- Certain medical conditions, including coeliac disease, diabetes, thyroid conditions, rheumatoid arthritis, chronic liver or kidney disease, low hormone levels, and some breast and prostate cancer treatments
- Prolonged use of corticosteroids
- Low levels of physical activity, particularly weight-bearing activity
- Smoking
- Excessive alcohol intake
Can osteopenia progress to osteoporosis?
Yes. If bone density continues to decline without management, osteopenia can progress to osteoporosis over time. The rate at which this happens varies between individuals and depends on a number of the risk factors listed above.
This is why an osteopenia diagnosis is worth taking seriously, even without pain or other symptoms. Osteoporosis is often called a “silent disease” because a bone fracture can be the first signal of something has been developing for years.
Supervised exercise is the key intervention
The current clinical recommendation for managing osteopenia is a guided and supervised exercise program delivered by an Accredited Exercise Physiologist (AEP). The program should include three types of activity:
1. Impact and weight-bearing activities Activities that apply force through the skeleton signal the body to maintain or build bone density: walking, heel drops, foot stamps, and progressing to jumping where appropriate. This is because bone responds to the mechanical load placed through it.
2. High-intensity progressive resistance training Exercises where your muscles work against a load (weights or resistance) pull on the tendons attached to your bones. This tugging force stimulates bone-building cells. For osteopenia, the AEP guidelines support working at a relatively high intensity, around 80 to 85% of your maximum effort, with a focus on back and leg exercises. The aim is two sessions per week of around 30 minutes each.
3. Balance training Most fractures associated with low bone density result from falls rather than spontaneous bone failure. Improving balance, lower-limb strength, and reaction time reduces the chance of a fall occurring. Aim for four sessions per week of around 30 minutes each. Activities like tai chi, line dancing, and ballroom dancing all count, as do specific balance challenges such as heel-to-toe walking on foam surfaces, stepping sideways over objects, walking backwards, walking on tiptoe, and single-leg standing.
One important note: loaded spinal flexion is not recommended for people with low bone density. This means avoiding exercises that involve bending forward under load. Activities that involve twisting (such as golf) or abrupt unusual movements (such as squash) should also be minimised or avoided, as these can increase fracture risk.
Nutrition matters too
Exercise and good nutrition work together. Key considerations:
- Meeting your daily calcium requirements through food or supplements
- Maintaining adequate vitamin D levels, which supports calcium absorption
- Eating a well-balanced diet
- Reducing alcohol intake and stopping smoking
A dietitian can provide individualised calcium guidance based on your current diet and any relevant medical conditions.
How an Accredited Exercise Physiologist can help
An AEP can assess your current bone density results, balance, posture, and muscle strength to establish a safe starting point. From there, they design a program that applies the right type of load in the right way, stimulating bone density without putting you at risk of injury.
This is particularly important for osteopenia because the same activities that build bone density can cause fractures if applied at the wrong intensity or sequence. A qualified professional manages that progression so the program is both effective and safe.
Bodytrack’s exercise programs for bone health are evidence-based and tailored to each individual. Chronic health conditions may be eligible for referral under Medicare’s GP Chronic Condition Management Plan and Private health fund eligibility may apply.
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Sources
- Healthy Bones Australia: bone density categories, and the difference between osteopenia and osteoporosis
- Royal Australian College of General Practitioners: management of low bone density in general practice
- Services Australia, GP Chronic Condition Management Plan: Medicare eligibility for allied health referral