One of the most common issues that women in menopause deal with is bone loss. Along with hot flashes, weight gain, mood swings bone loss is a common and legitimate concern. Unfortunately, many women don’t get screening for osteoporosis until they are in their late 50s and 60s. This is crazy! Unfortunately, many insurance companies will not cover the screening up until a certain age or for certain medical conditions. So, let’s be proactive and talk about how we as women can either prevent or reverse bone loss through diet, exercise, supplements, and lifestyle changes.
What is Osteopenia?
Before we get into how to prevent and reverse bone loss. Let’s make sure we are on the same page with terminology. Many of us are confused and assume that osteopenia and osteoporosis are the same thing. The are not.
Osteopenia is a condition characterized by bone density that is lower than normal but not low enough to be classified as osteoporosis. Bone density is a measure of the strength and thickness of your bones, and it’s assessed using a T-score from a dual-energy X-ray absorptiometry (DEXA) scan. In osteopenia, bone loss has begun but is not severe enough to result in fragile or easily fractured bones.
While osteopenia is not considered a disease, it is a warning sign. It indicates that your bones are losing density and could progress to osteoporosis if you don’t address it.
Osteopenia vs. Osteoporosis
Now that we know the definition of osteopenia, lets differentiate it from osteoporosis. Osteopenia and osteoporosis are both conditions involving low bone density, but they differ in severity:
- Osteopenia: T-score between -1.0 and -2.5. Bone density is below normal but not critically low. Fracture risk is increased but less than in osteoporosis.
- Osteoporosis: T-score of -2.5 or lower. Bone density is significantly reduced, greatly increasing the risk of fractures.
Osteopenia is often seen as a precursor to osteoporosis, but not everyone with osteopenia will develop osteoporosis.
Who Gets Bone Loss and Why?
Osteopenia is quite common, especially in women over 40. It affects up to 34 million Americans, with postmenopausal women being at the highest risk. The tricky thing about osteopenia is that you don’t have symptoms. Most of the time it progresses slowly until it’s either caught on a bone scan or you have a fracture.
There are many risk factors to osteoporosis, and they include:
- Age: Bone density naturally decreases as we age.
- Gender: Women are more likely to develop osteopenia due to lower peak bone mass and hormonal changes after menopause.
- Family History: A family history of osteoporosis or fractures increases your risk.
- Lifestyle Factors: Smoking, excessive alcohol intake, sedentary lifestyle, and low calcium or vitamin D intake can contribute to bone loss.
- Certain Medications: Long-term use of corticosteroids or other medications that affect bone health.
- Malnutrition or eating disorders: Poor nutrition or prolonged calorie deficit can lead to cessation in the menstrual cycle. This is due to low levels of estrogen which main action in bones is to prevent breakdown.
Causes:
- Hormonal Changes: Reduced estrogen levels in women after menopause.
- Nutritional Deficiencies: Lack of calcium, vitamin D, or protein.
- Medical Conditions: Hyperthyroidism, celiac disease, or chronic kidney disease.
How Is Osteopenia and Osteoporosis Diagnosed?
The most common diagnostic tool for osteopenia is the DEXA scan, which measures bone mineral density (BMD). Results are given as a T-score:
- Normal: T-score of -1.0 or higher
- Osteopenia: T-score between -1.0 and -2.5
- Osteoporosis: T-score of -2.5 or lower
Your healthcare provider may also consider factors like age, gender, family history, and lifestyle when making a diagnosis and recommending a treatment plan. There is also an online tool called FRAX which calculates your 10-year risk of fracture.
How to Interpret Results of a DEXA Scan
A DEXA scan provides a T-score and a Z-score:
- T-score: Compares your bone density to a healthy 30-year-old. This is the primary measure for diagnosing osteopenia or osteoporosis.
- Z-score: Compares your bone density to someone of your age, gender, and ethnicity. A Z-score below -2.0 may indicate bone loss due to a secondary cause.
If you are confused by your results, schedule an appointment with your primary care provider so they can explain the results in detail and provide you with recommendations.
Treatment for Osteopenia
The goal of treatment is to prevent further bone loss and reduce the risk of fractures. Common approaches include:
- Lifestyle Modifications:
- Exercise: Weight-bearing and resistance exercises can strengthen bones and improve balance, reducing fall risk.
- Nutrition: Ensure adequate calcium (1,000-1,200 mg/day) and vitamin D (600-800 IU/day) through diet or supplements.
- Healthy Habits: Quit smoking and limit alcohol intake.
- Medications:
- If bone density continues to decline or fracture risk is high, medications like bisphosphonates, selective estrogen receptor modulators (SERMs), or hormone replacement therapy (HRT) may be prescribed.
- Fall Prevention:
- Address hazards at home and improve strength and balance through exercises like yoga or tai chi.
I am all about lifestyle modifications and the good news is that there are plenty of non-medication options for reversing and treating bone loss backed with evidence-based research. So, let’s get into the details…
Natural Ways to Reverse Osteopenia
While osteopenia can feel like a wake-up call, the good news is that there are several natural ways to improve bone health and potentially reverse bone loss. These strategies focus on strengthening your bones, improving mineral density, and reducing your risk of progression to osteoporosis.
1. Prioritize Bone-Building Nutrition
Your diet plays a critical role in maintaining and improving bone density. Focus on these key nutrients:
- Calcium: Essential for building and maintaining strong bones. Aim for 1,000–1,200 mg of calcium per day. Great sources include fortified milks, tofu made with calcium sulfate, kale, broccoli, and almonds.
- Vitamin D: Helps your body absorb calcium effectively. Get your levels checked and aim for at least 2000 IU of vitamin D daily through sunlight exposure, fortified foods, or supplements.
- Magnesium: Crucial for bone formation and balancing calcium levels. Include foods like nuts, seeds, legumes, and dark leafy greens.
- Vitamin K2: Helps direct calcium to your bones instead of soft tissues. Found in fermented foods like natto, or consider a supplement if needed.
- Protein: Adequate protein is essential for bone repair and growth. Women over 40 should aim for at least 1–1.2 grams of protein per pound of body weight daily.
- Omega-3 Fatty Acids: Found in chia seeds, flaxseeds, and walnuts, omega-3s reduce inflammation, which may benefit bone health.
2. Engage in Weight-Bearing and Resistance Exercise
Exercise is one of the most effective ways to stimulate bone growth. Focus on:
- Weight-Bearing Exercises: Activities like walking, hiking, dancing, and jogging force your bones to work against gravity, promoting strength.
- Strength Training: Resistance exercises, such as lifting weights or using resistance bands, directly stress your bones, prompting them to rebuild stronger. Compound lifts like squats, deadlifts, and lunges are particularly effective. I recommend ALL women over 40 strength train at least 2 days per week. So important!
- Plyometrics: Exercises that involve jumping, like box jumps or skipping, help improve bone density in the hips and spine.
- Balance and Flexibility Training: Practices like yoga or tai chi can reduce your risk of falls and fractures by improving stability and coordination.
3. Adopt a Bone-Healthy Lifestyle
Small lifestyle changes can have a significant impact:
- Quit Smoking: Smoking accelerates bone loss by decreasing estrogen levels and impairing calcium absorption.
- Limit Alcohol: Excessive alcohol interferes with your body’s ability to absorb calcium and vitamin D. Stick to no more than one drink per day.
- Maintain a Healthy Weight: Being underweight can lead to bone loss, while excess weight may increase fracture risk. Aim for a balanced, sustainable weight.
- Reduce Sodium: High sodium intake can lead to calcium loss through urine. Limit processed foods and opt for whole, minimally processed options.
4. Manage Stress and Sleep
- Chronic Stress: High cortisol levels can weaken bones over time. Incorporate stress-reducing practices such as meditation, yoga, or breathing exercises.
- Sleep Quality: Poor sleep impacts bone regeneration. Aim for 7–9 hours of restful sleep each night.
5. Use Targeted Supplements if Needed
If diet alone isn’t meeting your nutritional needs, consider supplements:
- Calcium and Vitamin D: Supplements can be helpful if dietary intake is insufficient. Calcium citrate is a highly absorbable form.
- Collagen Peptides: Collagen provides building blocks for bone matrix and may improve bone density when combined with exercise.
- Strontium Citrate: A natural mineral shown to enhance bone formation and decrease bone resorption in early osteopenia.
6. Monitor Hormonal Health
Hormonal changes during menopause, especially reduced estrogen levels, can accelerate bone loss. Natural ways to support hormonal health include:
- Eating phytoestrogen-rich foods (like soy, flaxseeds, and lentils).
- Considering bioidentical hormone replacement therapy (BHRT) if appropriate, under the guidance of a healthcare provider.
- Managing stress to keep cortisol levels balanced.
7. Optimize Gut Health
A healthy gut helps your body absorb bone-boosting nutrients. Promote gut health by:
- Eating prebiotic and probiotic foods, such as bananas, onions, garlic, and fermented vegetables.
- Avoiding processed foods and sugar, which can harm the gut microbiome.
8. Stay Consistent with DEXA Scans
Regularly monitoring your bone density with DEXA scans will help track progress and guide your natural intervention efforts. Aim for scans every 1–2 years as recommended by your doctor.
By combining these natural approaches, you can strengthen your bones, slow or reverse osteopenia, and support your overall health. Consistency is key—small, daily actions add up to long-term improvements in bone health.
Conclusion
Bone loss unfortunately is part of the aging process. The good news is that we can not only prevent it but also reverse it. It’s not too late. Strong bones are essential for a lot of things. The main risk on our health with osteoporosis is fractures, which as we get older are related to a poor quality of life and increased mortality.
Did you know that:
- Women with osteoporosis are at a significantly higher risk of fractures, particularly in the hip, spine, and wrist. The lifetime risk of a fracture for women over 50 is approximately 50%, compared to 20% for men.
- Hip fractures are associated with a 20-30% increased mortality rate within the first year, particularly in older adults. Survivors often experience reduced mobility and independence.
Yikes, these are shocking statistics. The good news is you have control over a lot of things that cause bone loss. Take a look at your diet, start strength training, cut back on alcohol, stop smoking and reduce your stress!
Let me know in the comments below if you have any questions. I also have a customized 1:1 coaching program where I work with women to build muscle and improve their bone health. You get unlimited support, meal plans, exercise programming and so much more. Send me a message if you are interested! Talk to you soon!
