Bone Loss During Menopause: My Osteopenia Diagnosis
As a physical therapist, I talk to patients a lot about bone health and the benefits of strength training. Since I have also been fairly active my whole life, I never thought I would personally have to worry about getting osteoporosis. In fact, I even wrote another blog about bone density loss during menopause.
However, when my gynecologist recommended that I get a DEXA scan—since I have an auto-immune disease (Hashimoto’s) and have been in menopause for the past 6 years — she thought it would be a good idea to get a baseline as soon as possible rather than waiting until the recommended age of 65. I was all for it since I love data and being proactive about my health.
Well… what a gut punch it was when I found out that I have osteopenia! I was truly shocked. I am active, I eat healthy, I take HRT, I started jumping rope and doing high-impact activities (but only more recently), and I am a physical therapist who educates women on how to prevent and manage osteoporosis. How the heck can I have it?!
So, of course, I did a deep dive—as I do with most things related to health—and now I’m writing my second blog on this topic because it’s not only important, but also personal to me.
What is Osteoporosis?
Osteoporosis is a condition that weakens bones, making them fragile and more prone to fractures. It often develops silently, without symptoms, until a fracture occurs. The most common fracture sites are the hips, spine, and wrists.
How do you know if you have low bone density?
Early testing is key. The sooner you know, the sooner you can take action. A DEXA scan (Dual-Energy X-ray Absorptiometry) is the gold standard for assessing bone density. It can detect bone loss before fractures occur, allowing for early intervention.
This test is usually recommended for women over 65 or those with risk factors such as family history, previous fractures, or certain medical conditions such as rheumatoid arthritis and other autoimmune diseases.
But, if you ask your doctor for a referral, you can get one before that. Mine was fully covered by insurance.
Osteopenia versus Osteoporosis
Osteopenia: This is a warning sign. It means your bone density is lower than normal but not low enough to be considered osteoporosis. There are no symptoms, and it is only detected through a DEXA scan. Without intervention, it can progress to osteoporosis.
T-score range: -1.0 to -2.5
Osteoporosis: This means your bones are weak and at a higher risk of fracture, even from a minor fall.
T-score: -2.5 or lower, indicating significant bone loss
Bone Loss and Menopause Connection
Women can lose >10% of their bone density in the first 5–7 years after menopause. This rapid loss is due to hormonal shifts, specifically the drop in estrogen levels.
Prior to menopause, bone breakdown and bone formation are mostly balanced. But during menopause, estrogen levels drop dramatically, causing bone to break down faster than it rebuilds. This imbalance increases the risk of osteopenia, osteoporosis, and fractures.
Estrogen and Your Bones
Estrogen plays a crucial role in bone health. It helps your body absorb calcium from your diet and deposit it into your bones. It also:
Encourages osteoblast cells (the cells that build new bone tissue) to form more bone.
Slows down osteoclast cells (the cells that break down bone).
This is why, during menopause, when estrogen levels drop, bone breakdown begins to outpace bone formation—leading to osteopenia and osteoporosis.
Osteoporosis Is More Than Just Activity Level
Osteoporosis isn’t just about how active you are. It’s a condition influenced by many factors, and it often starts long before menopause. Some key contributors include:
Genetics
Hormones
Age
Nutrition
Lifestyle
Medications
What Contributed to My Osteopenia?
Looking back, a few things (besides the obvious of being menopausal) that may have contributed to my diagnosis:
✔️ Autoimmune Disease (Hashimoto’s)
✔️ Chronic high stress and elevated cortisol levels and not a great sleeper.
✔️ Missing essential nutrients, even with a healthy diet
✔️ Excessive alcohol consumption—especially from college through my late 40s
✔️ I stopped strength training for many years and was only doing Pilates. (Pilates is great for balance and stability, but not usually enough resistance to overload muscles).
These are factors that may have played a role in my diagnosis, but the primary ones are menopause and genetics. We all have unique health histories, genetics, and lifestyles that influence our bone health differently. The key is to stay informed, listen to your body, and make adjustments that work best for you.
While I can’t change the past, I can focus on what I do moving forward.
10 Things I’m Focusing on for Bone Health
1. Strength Training with Progressive Overload
Strength training stimulates bone growth and improves muscle mass.
You need to gradually increase reps, resistance, or tempo to stimulate bone adaptation.
2. Weight-Bearing Exercise (walking, dancing, pickelball)
Weight-bearing activities put stress on bones, stimulating bone formation.
I aim for 8,000–10,000 steps per day and wear a weighted vest at times.
3. Jumping Rope & High-Impact Training
Impact exercises like jumping, skipping, and plyometrics stimulate bone growth by putting stress on your bones, making them stronger.
4. Balance & Mobility Work
Preventing falls is just as important as building bone strength.
5. Taking MHT/HRT
Menopausal Hormone Therapy can help preserve bone density. It can slow bone loss by supplementing estrogen, which plays a key role in maintaining bone density. When started early in menopause, MHT has been shown to preserve bone and reduce fracture risk. Talk to your doctor to see if it’s a good option for you!
6. Eating Enough Protein
Protein is crucial for maintaining muscle mass and supporting bone health. Aim for at least 30 grams per meal from sources like lean meats, fish, eggs, dairy, tofu, or legumes. Strong muscles help protect your bones and reduce the risk of fractures!
7. Eating Calcium-Rich Foods and focusing on a Mediterranean diet. Supplementing with Calcium if needed.
Calcium is essential for bone strength. Aim to get calcium from foods like leafy greens, broccoli, dairy, and fatty fish, and consider supplementing if needed.
8. Supplementing with Vitamin D & K2
These help your body absorb and use calcium effectively. Vitamin D helps your body absorb calcium, and Vitamin K2 directs it to your bones. Don't forget to get some sunlight for natural Vitamin D!
9. Taking Magnesium & Creatine
Magnesium is essential for bone health, and creatine supports muscle mass.
10. Limiting Alcohol & Avoiding Smoking
Alcohol interferes with nutrient absorption, and smoking weakens bones.
Strength Training: A Key Pillar for Bone Health
One of the most effective ways to support bone health and reduce fracture risk is strength training. Bones need to be challenged to grow, just like muscles.
The key is prevention—but even if you’ve already been diagnosed, there are many things you can do to protect your bones.
Menopause Is a Critical Time for Bone Health
Although estrogen decline increases the risk of bone loss, there is so much we can do!
After posting about my osteopenia diagnosis on Instagram, a friend sent me a message that I really needed to hear. It resonated so deeply that I want to share it with you:
“You are so much more than one DEXA scan or your workout routine. Sometimes, all the health advice on IG makes us feel like if we just do everything right, we will be perfectly healthy. And when we aren't, we feel cheated or less worthy. But that’s not how life works. All we can do is our best—with whatever hand we’re dealt. You can make adjustments armed with information, but please don’t let it weigh you down or stop you from living a full and joyful life.”
This was exactly what I needed to hear, and I hope it resonates with you, too.
By taking proactive steps, you can protect your bones and reduce your risk of fractures. If you have any questions, reach out!
If you’re not already strength training and want to get started, check out my Meno-Strength 8-Week Program—designed for women in midlife and menopause. Or grab my FREE Meno-Strength Sampler Program. I’m here to help you get stronger and live your strongest, best life.
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