I’ve discussed osteoporosis a lot with my clients over the years and recently decided it was time to checkin on my own bone health. As a result of caring for my elderly parents the last ten years, I’ve become really focused on minimizing my risk for fall and fracture when I’m in my 60’s and 70’s– I want to avoid a hip fracture at all costs. I also look at the cute, frail women in wheelchairs every week when I walk into the assisted living and I think I’ve got to keep lifting and preserving my muscle and bones!
Estimates show that 50% of women over 50, and 20% of men over 50, will break a bone because of osteoporosis. Hip fractures are the most dangerous because they can lead to disability and death.
Despite being told “its not standard of care,” I wasn’t budging until I got a prescription for a DEXA scan. Like my serum lab markers, I wanted a baseline of where my bone density was and my insurance had no issue covering it. I was *slightly* shocked to see I had osteopenia at 48 yrs old. 
“I was *slightly* shocked to see I had osteopenia at 48 yrs old”
All I could think of was what did I miss? How is this possible given that I’m an active person and strength train, prioritizing protein, calcium and Vitamin D containing foods, limit my caffeine at all but stopped drinking alcohol!
How and Why?
We’re all unique humans so the given root cause of something for one is NOT the reason for another. For most women declining bone density could be a combination of age, genetics, declining hormones, nutrition and lifestyle factors, just to name a few.
For me, the short answer is chronic, unabated, unrelenting stress combined with rock bottom hormone levels, especially estradiol. Keeping in mind that chronic stress (chronic high states of cortisol) lower estrogen and testosterone on its own. Back in 2022, my morning cortisol levels were running higher than we’d like (this was confirmed with more reliable salivary testing which I offer clients in my practice) and my estradiol levels were “UNDETECTED” in my labwork.
Chronic Elevated Cortisol
Cortisol is essential, yet CHRONIC elevated levels of cortisol from unrelenting, unabated stress (think stressful relationships, stressful job, caring for elderly parents while caring for young children) creates belly fat, decreases serotonin and affects emotional regulation resulting in more mood swings. . High glucocorticoids, of which cortisol is a member of the family, reduces bone building and increases bone resorption, which are the ways that your bone remodels itself. Additionally, high glucocorticoids, from high stress and adrenal dysregulation – perhaps even taking corticosteroids – interfere with your ability to assimilate nutrients from food such as calcium and may indirectly lower other hormones like estrogen and thyroid.
“Chronic elevated levels of cortisol from unrelenting stress creates belly fat, decreases serotonin and affects emotional regulation”
Your sex hormones, estrogen and testosterone, also take a hit (hello low libido) and are important in maintaining your bone density.
*note, serum cortisol is an unreliable marker however we’ll still have it run to follow trends over time. It’s ideal to have it done shortly after waking. I find salivary cortisol testing done throughout the day to be a more reliable way to test.
6 Keys to Preserve Bone Density/Reverse Damage to Our Bones
1. Where can you slow down- honestly?
Where can you simplify your schedule? If you are struggling with a chronic condition, like rheumatoid arthritis or osteoporosis, it is a cry for help from your body. Open space in your week to just be. Ask yourself honestly, “Where can I slow down?”
2. Prioritize sleep
SLEEP IS NOT OPTIONAL and its one of the most potent interventions we can do for our health. (TIP: you can’t lose weight without deep restorative sleep.) We must prioritize it. You wouldn’t just put a newborn in a crib and turn the lights out and our adult selves are no different. We need a wind down routine that is relaxing and supportive – take a bath, sip some tea, fold laundry, play with a pet or read a pleasant book.
I love using blue light glasses an hour before bed and nowadays I make our dinner Rez for 530. Theres always exceptions .. this is 85% of the time.
3. Make room for movement.
- Flexibility and balance training are crucial to reduce the risk of falls and fractures, to improve overall mobility, and to enhance quality of life. Try standing on one leg while you brush your teeth or try single leg deadlifts if you currently strength train.
- Vertical weight bearing – that is, vigorous, high impact exercise – helps the bones most, such as jumping (old school jump roping!), plyometrics, stair climbing, squatting, and burst running. again start slow if you haven’t been exercising
- Your body and brain crave consistency so doing any movement at a consistent time each day is key.
4. Adequate nutrients (not just Calcium) are key! Ideally from food sources
- -Protein- this can become a full time job. Start with 100g- most of my clients aren’t even getting this much in. Your ideal amount is typically around 1g per Lb of bodyweight (120lb woman = 100-120g protein)
- -Calcium- ideally from food sources as supplements are often not as effective. If your body isn’t getting enough it’ll take it from your bones! Your body absorbs the calcium in dairy products more easily than plant based sources. I get acne w/ daily dairy so I aim to leverage small low mercury fish like sardines and mackerel (its legit just like tuna- don’t knock it til ya try it!)
- -Vitamin D-(aim for 25(OH)D levels to be at least 60 ng/ml ) necessary for the absorption of Calcium and your body can make it when its exposed to sunlight. eggs, rainbow trout and wild salmon have some of the highest amounts. If you’re supplementing please be sure its a D3 with K2 and have your Vit D levels checked to ensure its not too high or too low. Most do well with 2000iu taken with a meal
- -Magnesium- must be optimized PRIOR to increasing vitamin D. if you need to supplement avoid magnesium oxide or malate forms
- -Limit or avoid caffeine and alcohol
- -Stop smoking
5. Book bodywork -– for pain relief and stress reduction. Acupuncture, craniosacral, myofascial release are all good options to explore.
6. Consider “IFS parts work” and/or EMDR therapy-This has had a profound impact on my health and has personally been one of the best interventions I’ve ever done. The benefits of a therapist trained in polyvagal theory, somatic therapy, EMDR and parts work (IFS) is above and beyond what any supplement will ever do for your wellbeing.
For some, stress and trauma from past experiences holds us back from being able to let go of tension in the body. Past traumatic experience can lead to increased pain and function in autoimmune disease, and addressing it can lead to improved symptoms.
7. Get your Hormones Optimized– Have a conversation with a menopause literate provider (this may NOT be your gynecologist!) to determine if you are a candidate for hormone replacement therapy. AT minimum ask questions and become informed about how low estrogen affects your sleep as well as your bones. We have a lot of providers locally that are menopause literate!