23: Bone Health 101: What Every Woman Should Know
Ep. 23
I see it all the time in my practice: women who feel perfectly fine put off their DEXA scans, brush off conversations about medication, or think, “That won’t happen to me.” But the reality is sobering. Half of all women over 50 will break a bone because of osteoporosis. And in many cases, it could have been prevented.
What makes osteoporosis so dangerous is how quietly it develops. There’s no pain, no obvious symptoms—just a seemingly harmless moment, like moving a coffee table or missing a step, that ends in a serious, sometimes life-altering fracture. By then, your independence and quality of life may already be at risk.
This blog kicks off a three-part series on bone health, designed to give you the knowledge and tools you need to protect yourself. We’ll break down how your bones function, how menopause affects them, and what you can do to stay strong, starting today. You'll also learn the difference between osteopenia and osteoporosis, and how to assess both your lifestyle and medical risk factors.
Listen to the full episode:
Your Bones Are Living Structures
What might surprise you is that your bones aren't static structures like the frame of a house. They're actually living, breathing tissues that are constantly rebuilding themselves. If they weren't, they'd snap under the pressure of everything you do in a day, from bending, to twisting, jumping, and even just walking.
Think of your bones like a home renovation project that never ends. There are three main "workers" on the job site:
Osteocytes: The master planners (like Joanna Gaines) who coordinate the entire operation and decide what needs to happen
Osteoclasts: The demolition crew (think Chip Gaines with his sledgehammer) who break down old, worn-out bone tissue
Osteoblasts: The builders who lay down fresh, new bone material
In a healthy system, the demolition crew and builders work at equal rates, constantly remodeling your bones to keep them strong. It's a beautifully balanced process, until menopause comes along and changes everything…
What Menopause Does to Your Bones
When estrogen levels drop during menopause, this perfectly orchestrated system gets thrown off balance. The osteoclasts (demolition crew) keep working at full speed, chomping away at old bone. But the osteoblasts (builders) slow way down, meaning they're not laying down new bone as quickly.
The result? Weaker, more brittle bones. And since all women will experience declining estrogen as we age, this process has the potential to affect every single one of us.
Understanding the Stages of Bone Loss
Your bone density is measured against that of a healthy 30-year-old woman—the age when most of us reach peak bone mass. Here's how the three categories break down:
Normal Bone Density: Your bones are within the normal range compared to a 30-year-old (T-score between 0 and -0.9)
Osteopenia (Low Bone Mass): Your bone density has decreased but isn't yet at the osteoporosis level (T-score between -1.0 and -2.4)
Osteoporosis: Your bones are significantly weaker than average (T-score of -2.5 or lower)
Osteoporosis is often called a "silent disease," but that's not entirely accurate. It's more precise to say that osteoporosis is symptom-free until it becomes symptomatic—and by then, you're dealing with a fracture.
Many women come to my office complaining of joint pain, muscle aches, or back pain, thinking it might be osteoporosis. But those symptoms are actually signs of osteoarthritis, which affects your joints. Osteoporosis affects the long bones in your body and their structural strength—you literally won't feel it developing.
This is exactly why prevention matters so much. I've had patients who avoided bone density scans for years, insisting they felt fine. Then one day, they're moving furniture or stepping off a curb, and suddenly they're in a back brace with a compression fracture that changes their entire quality of life.
The Real-World Consequences
The statistics around fractures are sobering:
People over 85 who suffer hip fractures have a mortality rate as high as 50%
Fractures often lead to decreased mobility, which actually makes bones weaker over time
Many people never fully regain their pre-fracture quality of life
I had one patient in her late 70s who repeatedly declined bone density screening. She felt wonderful and had no family history of osteoporosis, so she wasn't worried. Then one day, while moving a coffee table, she suffered a compression fracture in her spine. Although we eventually treated her osteoporosis and she healed from the fracture, her quality of life was never quite the same. We'd lost precious years when we could have been preventing this outcome.
Risk Factors: What You Can and Can't Control
Understanding your risk factors helps you know when to take action and what lifestyle changes might help.
Modifiable Risk Factors (Things You Can Change)
Smoking
Drinking more than two alcoholic beverages daily
Sedentary lifestyle
Inadequate calcium or vitamin D intake
Insufficient protein to maintain muscle strength
Non-Modifiable Risk Factors (Things You Can't Change)
Age (risk increases significantly after 65)
Gender (women are at higher risk)
Ethnicity (Asian and Caucasian women start with lower baseline bone density)
Family history of osteoporosis or fractures
Certain medical conditions (rheumatoid arthritis, eating disorders, chronic kidney disease, hyperthyroidism)
Medications like steroids or potentially GLP-1 agonists
Early menopause (before age 50)
Low body weight (under 127 pounds)
When to Get Screened
The guidelines vary slightly between medical organizations, but here's what you need to know:
All women 65 and older should have a DEXA scan regardless of risk factors
Post-menopausal women over 50 who have high-risk factors should consider earlier screening
If you're Asian or Caucasian, have a family history of osteoporosis, take certain medications, or have other risk factors, don't wait until 65 to start the conversation with your doctor.
Knowledge Is Power
Your bones are your foundation, keeping you upright and mobile. The goal isn't to scare you, but to empower you with information so you can make informed decisions about your health.
In my next installment of the bone health series, we'll dive into how bone density scans actually work, what the results mean, and specific lifestyle strategies that can help keep your bones strong throughout your life. We'll also tackle the medication myths that keep too many women from getting the treatment they need.
Remember: feeling fine today doesn't guarantee your bones are fine. But with the right knowledge and proactive approach, you can work toward being part of the 50% of women who don't break a bone from osteoporosis.