Understanding ICD Codes for Osteoporosis and Osteopenia
…Or, Adventures in Navigating the Healthcare and Insurance System
Co-founder, Adrienne here. After a recent diagnosis of osteopenia at 38, I became very interested in learning about the technical differences between osteopenia and osteoporosis.
Both are relatively recent diagnoses and many people still lump “bad bones” into one informal diagnosis, suggesting an acceptance of the fractures and frailty we see in people (especially women) as they age. Well, we don’t accept fractures and frailty as an inevitable part of the aging process. With exercise, real food calcium chews like ours, and medication if necessary, these conditions are not inevitable.
Technical knowledge about the subtle distinctions in the diagnosis is also helpful. If you’ve ever looked at your medical records or insurance paperwork after a doctor’s visit, you may have noticed a series of codes next to your diagnosis. These are ICD codes, part of the International Classification of Diseases system that doctors and insurance companies use to categorize health conditions. While they might seem like just a string of numbers and letters, these codes can actually be helpful for patients, too—especially when it comes to managing osteopenia or osteoporosis.
Osteoporosis has different ICD-10 codes, mainly depending on the cause and whether fractures are present:
M81.0 – Age-related osteoporosis without current fractures
M81.8 – Other osteoporosis without current fractures (used when not related to aging)
M80.0-M80.9 – Osteoporosis with fractures (codes specify the affected bone, such as hip or spine)
M82.0-M82.8 – Osteoporosis caused by another medical condition (e.g., Cushing’s syndrome)
Osteopenia, considered a first warning sign of osteoporosis, means your bone density is lower than normal but not yet in the osteoporosis range. Osteopenia is the stage before osteoporosis, meaning bone density is lower than normal but not dangerously low. Osteoporosis, however, is a more advanced condition where bones become so fragile that even minor falls or stresses can cause fractures. Since osteopenia isn’t always classified as a disease, there isn’t a single ICD code for osteopenia, but doctors often use:
M85.8 – Other specified disorders of bone density and structure (commonly used for osteopenia, and this is what I have on my chart!)
So why should you care about these ICD codes for osteoporosis and osteopenia?
And why care about the technical distinction between osteoporosis and osteopenia? First, ICD codes and the proper diagnosis plays a big role in insurance coverage. I was able to get my DEXA scan covered only after I told my doctor about my fragility fractures and my family history of osteoporosis (my mother was diagnosed with osteoporosis in her 40s). If a treatment, bone density test, or medication is denied by your insurance, knowing the correct ICD code can make it easier to appeal the decision. These codes also ensure that if you’re seeing multiple doctors—like a primary care physician, an endocrinologist, or an orthopedic specialist—they’re all working together to understand your diagnosis. Finally, keeping track of your ICD codes can give you a clearer picture of how your bone health is progressing over time.
Remembering these distinctions and tracking the ICD codes has helped me navigate my medical record and be sure that I wasn’t paying more than I needed to for coverage. Now, my knowledge of this osteopenia diagnosis has motivated me to be more vigilant about my strength training. I didn’t need encouragement to take my calcium, however, since I enjoy my calcium chew complete every day!
Hope this helps you navigate the system and advocate for the care you deserve.
-Adrienne Bitar PhD, Co-Founder
