Bone health and DEXA Scans
I recently read a piece in the New York Times about DEXA scans and bone density during menopause (read it here), and it got me thinking about how much bone health tends to get overlooked until it can't be.
Bone loss is quiet. There's no ache that tells you your bones are thinning, no obvious sign until a fracture happens. And for women, the years around menopause are a particularly important and particularly under-discussed window. As estrogen declines, the balance between building new bone and breaking down old bone tips toward loss, and that process can move faster than most people realize.
So what can we actually do about it? A few things are within our control, starting today.
1. Strength Training Isn't Optional
Bone is living tissue, and like muscle, it responds to load. Weight-bearing and resistance exercise, think squats, deadlifts, carrying groceries, climbing stairs, lifting weights, signals to your body that it needs to maintain (or build) bone density. Cardio is great for your heart, but it's strength training that talks directly to your skeleton. If you're not currently doing any resistance work, even two sessions a week can make a meaningful difference over time.
2. Nutrition That Actually Supports Bone
Calcium gets all the attention, but bone health is a team effort:
Calcium from dairy, leafy greens, and fortified foods
Vitamin D, essential for calcium absorption; many people are unknowingly low, especially in winter months
Protein, since bone is partly made of collagen, a protein matrix that mineral attaches to
Vitamin K2 and magnesium, less talked about, but both play supporting roles in how calcium gets used and deposited
Adequate nutrition isn't a one-time fix. It's a long game, and the habits you build now compound over decades.
3. Know Your Medications
This one surprises people. A number of common medications can quietly affect bone density over time, including long-term steroid use, certain proton pump inhibitors, some anticonvulsants, and select hormone-related treatments. This isn't a reason to panic or stop necessary medication on your own, but it is a reason to ask your doctor directly: "Does anything I'm taking affect my bones, and should that change how I'm monitoring them?"
Where I Land on Earlier DEXA Scans
Most current guidelines recommend routine DEXA screening starting around age 65 for women (earlier if you have specific risk factors). Screening guidelines are built around population-level evidence, cost-effectiveness, and avoiding over-testing.
But here's where I differ, personally: I don't think we should have to wait for research to catch up before we're allowed to know our own numbers. A baseline scan in your 40s or 50s doesn't just tell you whether you have osteoporosis today. It gives you a reference point. It lets you and your doctor track change over time, rather than only intervening once you're already in a danger zone. Even without a formal guideline mandating it, having that information sooner feels like the kind of proactive, informed choice that adults should get to make for their own health.
Delaying access to information about our own bodies has rarely served women well. I'd rather know early and act early than wait for permission.
If you live in the Boston-area and your insurance does not cover DEXA scans before the age of 65, I had a wonderful experience at DexaFit Boston (no affiliation with them, just a happy customer!).
