What Is Osteoporosis and Osteopenia?
Bone health becomes increasingly important as we age, particularly during and after menopause.
Most professional societies recommend bone mineral density (BMD) testing for all women beginning at age 65. However, women with certain risk factors may benefit from earlier evaluation.
If you have concerns about bone health, a personalized discussion can help determine whether screening is appropriate for you.
What Is Osteoporosis?
The National Institute of Arthritis and Musculoskeletal and Skin Diseases defines osteoporosis as:
“Osteoporosis is a bone disease that develops when bone mineral density and bone mass decreases, or when the structure and strength of bone changes. This can lead to a decrease in bone strength that can increase the risk of fractures (broken bones).”
Over time, reduced bone strength may increase the risk of fractures, particularly in the hip, spine, and wrist.
Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases
https://www.niams.nih.gov/health-topics/osteoporosis
What Is Osteopenia?
Osteopenia refers to lower-than-normal bone density that is not yet severe enough to be classified as osteoporosis. It may increase the risk of future bone loss and fracture if progression occurs.
Early identification allows for discussion of monitoring and risk-reduction strategies.
Risk Factors for Osteoporosis
Risk factors may include:
• Personal or family history of fracture
• Rheumatoid arthritis
• Cushing syndrome
• Chronic kidney or liver disease
• Hyperthyroidism
• Type 1 diabetes
• Anorexia nervosa
• Hemochromatosis
• Use of certain medications such as aromatase inhibitors, immunosuppressants, long-term excessive thyroid hormone, or certain anti-seizure medications
• Advanced age
• Smaller body frame
• Sedentary lifestyle
• Excessive alcohol intake
• Genetic predisposition
Having risk factors does not mean you will develop osteoporosis, but they may influence screening and prevention strategies.
Lifestyle Considerations for Bone Health
Lifestyle strategies may help support bone health and slow age-related bone loss. These include:
• Adequate intake of calcium, magnesium, vitamin K, and vitamin D, ideally from dietary sources when possible
• Weight-bearing and resistance exercise
• A nutrient-dense eating pattern that includes sufficient protein
• Limiting excessive alcohol intake
• Avoiding tobacco use
Some professional guidelines recommend approximately 600–800 IU of vitamin D daily for most adults, though individual needs may vary based on lab results and clinical assessment.
Exercise recommendations commonly include at least 150 minutes of moderate activity weekly, incorporating both weight-bearing and strength-based movement.
Lifestyle interventions may help reduce risk but do not eliminate the possibility of bone loss.
Hormone Therapy and Bone Health
Research, including data from the Women’s Health Initiative, has shown that estrogen therapy and combined estrogen-progestin therapy can reduce fracture risk in certain postmenopausal women.
Hormone therapy is not appropriate for everyone. Decisions regarding menopausal hormone therapy should be individualized and based on:
• Age
• Time since menopause
• Personal and family medical history
• Cardiovascular and cancer risk profile
• Overall health goals
A thorough evaluation is essential before initiating treatment.
Medications for Osteoporosis
Several medications are approved to treat osteoporosis and reduce fracture risk. These may include:
• Bisphosphonates
• Selective estrogen receptor modulators (SERMs)
• RANK ligand inhibitors
• Parathyroid hormone receptor agonists
• Calcitonin
These therapies should be prescribed and monitored by a qualified healthcare professional based on individual risk assessment.
When to Seek Evaluation
If you have risk factors, a history of fracture, or concerns about bone health during perimenopause or menopause, consider scheduling a consultation to discuss whether bone density testing or preventive strategies may be appropriate for you.
Selected References
Cauley, J., et al. (2003). Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women’s Health Initiative randomized trial. JAMA, 290(13):1729–1738.
Jackson, R., et al. (2006). Effects of conjugated equine estrogen on fracture risk and BMD in postmenopausal women with hysterectomy. Journal of Bone and Mineral Research, 21(6):817–828.
