The Bone Density Wake-Up Call: What to do NOW (and why it matters)

65 is when most women measure it. 40+ is when you protect it.

Waiting until your first DEXA scan at 65 to care about your bones is like checking your retirement account the year you want to retire.

Our bone health: We typically don’t think about it, we don’t measure it early enough, and we assume all is well. Then we hit the age when screening is commonly recommended, and so many women are surprised by what they see.  I’m here to help change the game with your bone health and empower you to do something about it before you’re forced into trying to play catch up. 

Why You Should Care: 

• In the US (2017–2018), the CDC estimated that the prevalence of osteoporosis among women ages 50 and older was almost 20%. That’s one in 5 women!

• The prevalence of low bone mass, a precursor of osteoporosis, among women ages 50 and over is over 43%. That’s almost half of women walking around with a high chance of developing osteoporosis. (1)

• Low bone mass contributes to fall and fracture risk. Hip fracture (2) in older adults (65 years or older) results in high chance of substantiation disability (46%) and dealth 28%  within a year. (3)

This guide is Part 1 of a 2-part series:

• Part 1: Why bone density declines, what sets you up for it, and why this starts long before 65

• Part 2: Exactly what to do (training, nutrition, minerals, screening, and a practical action plan)
  

Why 65 is the age most women finally pay attention

In the US, routine osteoporosis screening is commonly recommended for women age 65 and older* (4) (5). Here’s the problem: bone loss is often silent. You can’t feel your bone density declining. Typically women find out after a scan or fracture when in reality, low bone density is very preventable through a healthy lifestyle. 

Quick definitions (so we’re speaking the same language)

• Bone mineral density (BMD): A measure used as a proxy for bone strength.

• Osteopenia: Lower-than-normal BMD. Think: yellow light, time to take action! 

• Osteoporosis: Significantly low BMD and higher fracture risk. Think: red light-time for serious, structured plan (and yes you can improve your trajectory)

• DEXA scan (DXA): The standard scan used to measure bone density.
  

The part most women miss: bone density is built (and lost) over decades

Bone is living tissue. It responds to what you do repeatedly.  So if you’re 40+ reading this, you’re not late. But you are in the window where the slope can change.

The early-life “bone health withdrawals” that set women up for low BMD

This is the section where I want you to feel empowered, not blamed. Most of these are “normal” patterns in modern life.

1) Chronic dieting and under-eating (including “clean” dieting)

If you’ve spent years in a cycle of:

• Eating too little

• Consistently attempting to lose weight

• Losing weight only to regain

you’ve very likely been making withdrawals from your bone and muscle bank.

Under-fueling can reduce the body’s ability to build and maintain tissue. And bone is tissue.

2) Not eating a nutrient-dense diet (and yes, that can mean not eating enough even if it is “healthy”)

Bone is not built from motivation. It’s built from raw materials. If your diet has been low in: protein, minerals, or not enough calories overall, your body doesn’t have enough building blocks to work with. This is one reason why “I eat healthy” isn’t always the same as I fuel my body for health and longevity. 

3) Not building bone-protecting muscle in your younger years

A lot of women spent their 20s and 30s doing some combination of:

• lots of cardio

• minimal strength training

• Lifting light weights that never actually build muscle. 

Cardio can be great for health. But bone density responds best to progressive mechanical loading.

4) Low protein intake (Protein is the building block of muscle)

Dietary protein is one of the main building blocks your body uses to maintain and repair tissue, and build muscle.

When protein intake is chronically low, a few things tend to happen:

• You fail to build muscle, even if you’re lifting weights, which reduces strength, stability, and resilience.

• Recovery gets worse, so training becomes harder to do consistently. 

• You end up with less protective tissue overall, which matters because bones don’t live in isolation.
  

And yes, theres a direct bone connection too: bone responds to load, and load comes from muscles pulling on bone. Chronically low protein (many women need a lot more than they think!) makes it harder to build and maintain muscle. Less muscle means:

• less stimulus for bone

• less strength and stability

• higher fall risk
  

That last point matters because fractures are not just about bone density. They’re also about falls. 

5.) Alcohol (a lifetime compounding stressor)

Alcohol is a toxin. Your body treats it like one, prioritizes clearing it, and that has ripple effects.

Over time, alcohol intake can contribute to worse bone outcomes and higher fracture risk through a few pathways:

• Nutrient displacement: alcohol can crowd out nutrient-dense food choices and make it harder to consistently hit protein and micronutrient needs.

• Nutrient depletion and metabolism: alcohol can interfere with how your body absorbs, uses, and stores key nutrients involved in bone and muscle health.

• Hormones and recovery: it can disrupt sleep and recovery, which are when your body rests, repairs, and adapts to training. 

• Balance and falls: it can impair coordination and stability, increasing fall risk.

• Consistency: it often chips away at the habits that protect bone long-term, like lifting, eating enough, and recovering well.

It’s not the occasional drink, it’s the pattern. 

6) Sedentary life and exercise that never progresses

If your workouts never progress, your bones don’t get a reason to adapt. Walking and pilates can be fantastic for many goals but for bone density, the key concept is progressive overload which we generally need strength training to elicit. (we’ll go deeper in Part 2).

7) Smoking and nicotine use

Smoking is consistently associated with lower bone density and higher fracture risk. If this is part of your history at any point, it’s a risk factor worth considering.

Medications and medical factors that can impact bone (often overlooked)

This is not a “stop your meds” message. This is a “know what to ask” message.

If any of these apply to you, it’s worth bringing up bone health proactively:

• Long-term glucocorticoids (steroids) like prednisone

• Long-term proton pump inhibitors (PPIs) for reflux (omeprazole, etc.)

• SSRIs (some evidence links use with fracture risk)

• Aromatase inhibitors and other hormone-modulating therapies

• Certain anti-seizure medications

• Thyroid hormone replacement if dosing is too high (pushing hyperthyroid)

• Depo-Provera (injectable contraception) in bone density context

• Malabsorption conditions (celiac disease, IBD), bariatric surgery history

• Chronic inflammatory conditions
  

Then midlife hits: what compounds risk with age

Here’s the midlife reality: even if you did “everything right,” the rules can change.

Menopause is a bone inflection point

During the menopause transition, declining estrogen can accelerate bone loss. That’s why this conversation belongs in midlife, not just in your 60s. This is also where an individualized medical conversation may matter. For many women, hormone therapy is part of a comprehensive plan to help minimize bone loss and to discuss with a trusted and educated clinician.

What happens when bone density declines:

When bone density declines, the risk isn’t just a number on a scan. It’s what that number can lead to including:

• Higher fracture risk, especially hip, spine, and wrist

• Vertebral compression fractures, which can show up as height loss, posture changes, or back pain

• Pain and reduced activity (and then less activity leads to less strength, which leads to more risk)

• Longer recovery after falls and injuries
  

The takeaway (Part 1)

If you’re waiting until 65 to think about bone density, this is what has been normalized.  Unfortunately it’s the cultural default, but now that you know the risks, you have leverage and in Part 2, we’ll use it.

Next up (Part 2): The bone-building blueprint: progressive strength training, protein, minerals (calcium, vitamin D, magnesium), fall-proofing, and when to discuss screening earlier.

References

1. Centers for Disease Control and Prevention. Osteoporosis or low bone mass in older adults: United States, 2017–2018. NCHS Data Brief, no 405. Hyattsville, MD: National Center for Health Statistics; 2021. Available from: https://www.cdc.gov/nchs/products/databriefs/db405.htm

2. ScienceDirect. Hip Fracture. [Internet]. [cited 2026 Feb 6]. Available from: https://www.sciencedirect.com/topics/medicine-and-dentistry/hip-fracture

3. Snoeren MM, van de Ree CLP, de Monyé C, Emmelot-Vonk MH, Dijkgraaf MGW, Spruit M, et al. The cost-effectiveness of screening for osteoporosis in patients with a recent fracture: A systematic review. Injury. 2020 Jan;51(1):2–10. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0020138319307557

4. U.S. Preventive Services Task Force. Osteoporosis to prevent fractures: Screening. 2018 Jun 26. Available from: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/osteoporosis-screening

5. Medicare.gov. Bone mass measurements. [Internet]. [cited 2026 Feb 6]. Available from: https://www.medicare.gov/coverage/bone-mass-measurements