Bone Health in Midlife: What We Need to Know Now

Woman's back with tatoo on spine.

We don’t tend to think about our bones or bone strength—until something breaks. Osteopenia and osteoporosis are often associated with frail, much older women, but the reality is far more immediate. Women lose up to 5% of their bone mass in the first five years of menopause alone.

As estrogen declines, osteoclast activity increases, meaning bone is broken down faster than it can be rebuilt. When this accelerated bone loss is layered on top of other risk factors—such as a history of limited weight-bearing exercise, disordered eating, medications that affect bone health, or never reaching peak bone mass—it’s not uncommon for women to face a diagnosis of osteoporosis in their early 50s.

This is where knowledge truly becomes power.

Having access to your own health data allows you to make informed, proactive decisions. A DXA scan is a bone density test that uses very low-dose radiation—about the same exposure as flying across the country—to measure bone density in the spine and hips. Many women are first told to get a DXA scan in their 60s, often more than a decade post-menopause. By then, the results can feel confusing, alarming, and overwhelming, with little clarity on what to do next.

In my work with women across midlife, I encourage those in their 30s to consider a DXA scan as a baseline. This provides a snapshot of peak bone mass before estrogen begins to decline in perimenopause. If you’re in your 40s, it’s absolutely not too late. This information can guide what to prioritize—strength training, cross-training, nutrition, stress management, and targeted supplementation.

If you’re in your 50s and haven’t had a DXA scan yet, now is the time. Many insurance plans will cover it, and if not, the out-of-pocket cost is often around $150 or less.

We’re also fortunate to now have an additional tool that can be added to a DXA scan: Trabecular Bone Score (TBS). This test evaluates the actual microarchitecture of the bone and provides a more accurate assessment of fracture risk. I’ve included a link to help you find providers who offer both DXA and TBS testing.

If there’s one thing to remember, it’s this: osteoporosis is often called the silent disease. Bone loss happens quietly, without symptoms—until a fracture occurs. And when a hip fracture happens, the statistics are sobering: approximately 20% of individuals will not survive within a year.

Bone health is not something to put off. It’s something to understand, support, and protect—starting now.

Bone health isn’t about fear—it’s about awareness. Understanding what’s happening beneath the surface allows you to take meaningful action long before a crisis occurs. If you’re curious about your bone health, unsure when to get a DXA scan, or want guidance on how to support your bones through nutrition, movement, and lifestyle, I’d love to support you. Schedule a complimentary discovery call and let’s talk about what your next best step could be.