Despite the well-established connection between menopause and bone loss, DEXA scans—the primary screening tool for osteoporosis—are typically not recommended until age 65. That means many women spend over a decade unaware of their bone status—while hormonal shifts quietly accelerate bone loss year after year.
Osteopenia, which indicates lower-than-normal bone density, can progress silently. Osteoporosis is a more advanced stage, where bones become fragile and significantly more prone to fracture.
Let’s start with the obvious: the standard of care is broken.
The gap in early detection leaves many women blindsided—and shocked to learn they have osteopenia or osteoporosis.
Menopause—and the hormonal cascade that accelerates bone loss—typically begins around age 50.
That means there’s often a 15-year silent gap, where bone density is declining…and no one is checking.
We wouldn’t wait 15 years to test for high blood pressure or cholesterol. Why are we doing that with bones?
Early detection matters. It’s important to proactively request this test.
If you’ve already been diagnosed, you’re not alone—and it’s not too late to take action.
The Whole Picture
What’s often missing from the conversation? Bone density isn’t the whole story.
Many providers only look at your DEXA T-score, but other tests can offer a more complete picture of what’s happening in your body:
Bone turnover markers – A group of lab tests that show how actively your body is building and breaking down bone. These give a dynamic view of bone metabolism—unlike a DEXA scan, which is a static snapshot.
- CTX (C-terminal telopeptide) – Measures osteoclast activity, how quickly you’re breaking down bone. High levels suggest rapid bone loss or poor response to treatment. It provides a dynamic picture of bone metabolism—whereas a DEXA scan is just a static snapshot
- P1NP (Procollagen Type 1 N-terminal Propeptide) – Indicates new bone formation (osteoblast activity). Often paired with CTX for a full picture of bone turnover.
- Hormone panels – Assess estrogen, testosterone, thyroid, and cortisol—key hormones that impact bone metabolism and muscle maintenance. These are typically ordered by functional or integrative medicine practitioners who use blood, saliva, or urine testing to get a more complete hormonal picture.
- Nutrient levels – Especially vitamin D, magnesium, and calcium, which are essential for bone health and repair.
Most primary care providers (PCPs) don’t routinely order these tests—but if you ask clearly and explain why they matter, some will. If not, a functional or integrative medicine practitioner may be your best route.
And there’s hopeful data too: Several bone health experts and certified coaches report that strength training, paired with smart nutrition and supplementation, may not only prevent further loss, but also improve bone quality—even if DEXA numbers don’t drastically change.
Bone is living tissue. That means it can respond to lifestyle—especially when caught early.
What You Can Do Now: The Lifestyle Protocol
This isn’t just about calcium—and calcium alone isn’t enough. Bone health is a whole-body systemic issue—shaped by hormones, muscle strength, digestion, and inflammation.
Here’s where to focus:
Strength Training
- Weight-bearing and resistance exercise signal the body to lay down more bone.
- Focus on compound movements like squats, lunges, and presses. Work with a trainer if you’re unsure about form or just getting started.
Protein Intake
- Aim for at least 1g of protein per pound of ideal body weight—especially as you age and your needs increase.
- Protein builds muscle—and muscle supports bone.
Supplemental Support:
- Magnesium – helps activate vitamin D and supports more than 300 body functions. Try these types:
- Glycinate – Calming, supports sleep and anxiety relief.
- Citrate – Helps with digestion, mild laxative effect, supports muscle/nerve function.
- Malate – Great for energy, aches, and muscle fatigue.
- Threonate (sometimes seen as Magtein®, its patented form) – Best for cognitive support; crosses the blood-brain barrier.
Many quality bone or menopause supplements use a magnesium blend to boost absorption and support multiple systems. Always check the elemental magnesium—that’s the actual amount your body absorbs—not just the total compound weight. For example if 500 mg is the total compound (magnesium + glycine), the elemental magnesium—the part your body actually uses—might only be 70–100 mg.
Avoid Magnesium oxide (common in cheaper supplements but poorly absorbed) and Magnesium aspartate & glutamate which can have stimulating effects.
- Vitamin D + K2 – It’s ideal to combine vitamin D3 with K2 for better calcium absorption and bone support.
- Vitamin D3 helps you absorb calcium. Get blood levels checked; most need 2,000–5,000 IU/day.
- Vitamin K2 (MK-7 form) directs calcium to bones instead of arteries. Often missing in Western diets.
A good D3/K2 combo supplement supports calcium utilization and bone strength—especially post-menopause.
- Creatine Monohydrate
- Commonly used by athletes to support muscle strength, power, and recovery.
- For women over 50, creatine may also support bone density—especially when combined with resistance training—and emerging research points to added benefits for mood and cognitive function.
- Emerging research suggests additional benefits for cognitive function and mood.
- Monohydrate is the most studied, effective, and bioavailable form—avoid blends with unnecessary additives.
Dose: 3–5g/day, ideally with a meal or after your workout. Start small and build gradually if you’re new to it.
Minimize Ultra-Processed Foods
- Ultra-processed foods fuel inflammation, blood sugar swings, and nutrient depletion.
- Prioritize whole, minimally processed foods. Cook when you can—it doesn’t have to be fancy.
Watch Alcohol + Caffeine
- Alcohol and caffeine can interfere with calcium absorption and disrupt hormonal balance.
- Be mindful—especially if you’ve already been diagnosed with bone loss
Quit Smoking
Smoking is one of the most overlooked—and impactful—risk factors for osteoporosis.
It disrupts hormone levels, reduces blood flow to bone tissue, and interferes with calcium absorption—all of which accelerate bone loss. It also lowers estrogen levels, which are essential for maintaining bone—especially after menopause.
Gut Health
- You can’t properly absorb key bone-building nutrients—like calcium, magnesium, vitamin D, and K2—if your gut is inflamed or out of balance.
- Dysbiosis (imbalanced gut bacteria) can drive systemic inflammation, which contributes to bone breakdown.
- A healthy gut microbiome supports the production of short-chain fatty acids that play a role in bone remodeling.
- Consider adding probiotics (especially Lactobacillus and Bifidobacterium strains), fermented foods (sauerkraut, kefir, kimchi), and fiber-rich veggies to feed your gut bacteria.
- Limit sugar, alcohol, and ultra-processed foods—they harm your gut lining and reduce microbial diversity.
💡 Tip: A stool test through a functional provider can help assess microbial balance and inflammation markers.
A Word on Medication
You may be offered bisphosphonates (like Fosamax, Reclast, or Boniva) or newer medications like Prolia.
These drugs aim to slow bone breakdown and reduce fracture risk—but they come with tradeoffs.
What they do: Most osteoporosis drugs suppress the activity of osteoclasts (cells that break down bone), helping retain or slightly increase bone density. Some newer meds, like Forteo or Tymlos, actually stimulate bone formation.
What to consider:
- They may increase bone quantity, not necessarily quality. Denser bone isn’t always stronger.
- They can cause side effects, including joint pain, digestive issues, fatigue, or flu-like symptoms after infusions.
- Rare but serious risks include osteonecrosis of the jaw (especially after dental work) and atypical femur fractures.
- Some, like Prolia, cause rebound bone loss if stopped abruptly.
- Long half-life: Bisphosphonates stay in your bones for years—even after stopping. This means any side effects—or risks—may linger far longer than expected.
Some women opt to use medication short-term while making foundational lifestyle changes. Others decline meds altogether and go all-in on strength training, nutrition, and targeted supplementation.
Either way—you deserve informed consent and shared decision-making. Ask your provider about the risks, potential benefits, and how long you’d realistically be on it.
Final Thoughts
Bone is a living tissue. That means it can adapt, rebuild, and respond to the choices you make—especially when you start early.
- Start small.
- Lift heavy (safely).
- Eat more protein.
- Be consistent with your supplements.
- Nourish your gut.
- Get sunlight.
- Prioritize rest.
You didn’t fail—the system did.
But now? You get to choose differently. You get to advocate for you.
Want to Take Action? Start Here:
📍Menopause Musculoskeletal Syndrome (MMS): What Every Woman 50+ Should Know
📍Eat to Feel Good
📍 3-Day-a-Week Strength Training Plan
📍 The 30-Day Reset
📍Feel to Heal
“Osteoporosis is not a disease—it’s a symptom of imbalance in the body. Your bones don’t break down in isolation.”
— Dr. Susan Brown
