Osteopenia is extremely common. Among U.S. adults aged 50 and older, 43.1% have low bone mass at the hip, spine, or both, according to CDC data from the National Health and Nutrition Examination Survey. That translates to nearly half of all older adults walking around with bones that have started to thin but haven’t yet reached the threshold for osteoporosis. Women are affected more often than men: 51.5% of women over 50 have low bone mass, compared to 33.5% of men in the same age group.
What Osteopenia Actually Means
Osteopenia is the zone between normal bone density and osteoporosis. It’s diagnosed with a DXA scan, which uses low-dose X-rays to measure the mineral content of your bones, typically at the hip and spine. Your result comes back as a T-score, which compares your bone density to that of a healthy 30-year-old. A T-score between -1 and -2.5 falls in the osteopenia range. Below -2.5 is osteoporosis.
Because the cutoff is based on a statistical distribution, a large number of people will naturally fall into this middle zone as they age. Osteopenia isn’t a disease in itself. It’s a marker of where your bones sit on a spectrum, and it signals that your fracture risk is higher than someone with normal density, though lower than someone with osteoporosis.
Prevalence by Sex and Ethnicity
The gap between men and women is significant. Women lose bone rapidly in the years following menopause because of the drop in estrogen, which plays a major role in maintaining bone density. By age 50, roughly one in two women already qualifies for an osteopenia diagnosis. For men, the rate is about one in three, still remarkably high but slower to develop because testosterone declines more gradually.
Ethnicity also plays a role. Data from the NHANES survey found that non-Hispanic white adults had the highest osteopenia prevalence at 25.5%, compared to 18.5% among Hispanic adults and 16.3% among non-Hispanic Black adults. Black Americans tend to have higher peak bone mass, which provides a larger reserve as bone loss begins with aging. These numbers come from a slightly different age range and measurement approach than the overall 43.1% figure, but the pattern is consistent across studies.
Global Estimates
The U.S. numbers are not unusual. A systematic review published in JMIR Public Health and Surveillance estimated the global prevalence of osteopenia at about 40%, with osteoporosis affecting roughly 20% of the population. That means low bone mass of some degree affects a majority of older adults worldwide. China ranks among the top five countries for disability related to osteopenia and osteoporosis-related fractures, largely because of its enormous aging population.
Younger Adults Are Not Immune
Osteopenia is overwhelmingly a condition of aging, but it can show up in younger people under certain circumstances. The most well-documented example involves female athletes who lose their menstrual periods due to intense training and low energy availability. Research on competitive collegiate cross-country runners found that 56% had irregular or absent periods. Those athletes had bone density 8 to 31% lower than teammates who menstruated normally, and some had bone density comparable to women in their 70s and 80s.
The consequences are real and immediate. In the same group of runners, 44% had experienced at least one stress fracture, and the risk was two to four times higher for athletes with menstrual irregularities. Other conditions that can cause early bone loss include eating disorders, long-term corticosteroid use, celiac disease, and hormonal disorders. For most people under 50, though, osteopenia is rare unless one of these specific risk factors is present.
Who Gets Screened
The U.S. Preventive Services Task Force recommends DXA screening for all women aged 65 and older. For postmenopausal women younger than 65, screening is recommended if risk factors are present, including low body weight, a parent who fractured a hip, smoking, or heavy alcohol use. The task force suggests a two-step approach for this younger group: first assess risk factors, then order a DXA scan if the risk profile warrants it.
For men, the picture is less clear. The task force currently says there isn’t enough evidence to recommend for or against routine screening in men, despite the fact that a third of men over 50 have low bone mass. In practice, many doctors will order a DXA for men who have clear risk factors like long-term steroid use, low testosterone, or a history of fragility fractures.
Why the High Numbers Matter
The sheer prevalence of osteopenia raises an important question: if nearly half of older adults have it, is it just normal aging? To some extent, yes. Bone density peaks around age 30 and declines steadily after that. Some loss is inevitable. But the label matters because it identifies people whose bones are thin enough to benefit from intervention before they reach osteoporosis or break a bone.
Not everyone with osteopenia needs medication. For many people, the practical response involves weight-bearing exercise, adequate calcium and vitamin D intake, and avoiding smoking and excessive alcohol. The goal is to slow the rate of bone loss and reduce the chance of crossing into osteoporosis territory. For those with T-scores closer to -2.5 or with additional fracture risk factors, the conversation about treatment becomes more urgent. Bone density can be rechecked every few years to track changes and adjust the plan.