Your Bones Need Exercise Too: What Women Should Know About Bone Health and Menopause

If you think about bone health as something to worry about “when you get older,” you’re not alone. But your bones have been responding to your daily movement, exercise, nutrition, and hormones for your entire life. A recent New York Times article explored an important question for women approaching or going through menopause: Should you get a DEXA scan earlier than the traditional screening age? The answer isn't quite as simple as “yes” or “no.” But there is a takeaway that is especially relevant to physical therapy: You don't need to wait for a bone-density scan to start taking care of your bones.

What happens to your bones during menopause?

Our bones are living tissue, which means they are constantly breaking down and rebuilding. We build much of our peak bone mass during our younger years, and physical activity plays an important role in that process. Weight-bearing activity such as walking, running, jumping, and resistance training, gives your bones a reason to maintain and build strength. Around menopause, things change. Estrogen levels decrease significantly, and this can accelerate bone loss. According to the New York Times, women can lose an average of about 10% of their bone density during the five to seven years following menopause. That doesn't mean that every woman will develop osteoporosis.But it does mean that midlife is an important time to pay attention to bone health. Your starting bone density, genetics, nutrition, activity level, body weight, smoking history, alcohol intake, certain medications, and medical conditions can all influence your risk.

So, do you need a DEXA scan?

A DEXA (or DXA) scan is a low-radiation test that measures bone mineral density, usually at the hip and spine. It can help identify low bone density and osteoporosis and can help your medical team determine fracture risk and treatment options. Current recommendations generally call for routine bone-density screening in women 65 and older, with earlier screening considered for postmenopausal women who have additional risk factors for fracture. That is important because there has been a growing conversation online suggesting that all women should get a baseline DEXA scan in their 30s or 40s. The evidence doesn't currently support routine DEXA screening for every younger woman at average fracture risk. However, if you have risk factors for osteoporosis or fracture, an earlier conversation with your physician may be appropriate. The important distinction is this: You can take bone health seriously without necessarily needing a DEXA scan right now.

What does this have to do with physical therapy?

A lot, actually. One of the most effective things you can do for your bones is give them a reason to stay strong. That means progressively challenging your body through resistance and weight-bearing exercise.

1. Strength training matters

Your bones adapt to the loads placed on them. That doesn't mean you need to become a powerlifter, but you might start with:

• Squats 

• Step-ups

• Lunges

• Deadlift variations

• Rows

• Push-ups or pressing exercises

• Carrying weights

• Resistance-band exercises

  
  

The goal is to gradually increase the challenge as your body adapts. You don't have to start heavy. In fact, starting at an appropriate level and progressing over time is often more important than choosing an arbitrary amount of weight. This is one reason working with a physical therapist can be valuable: we can help determine where you should start and how to progress safely.

2. Impact can be important, too

Resistance training isn't the only form of exercise that can benefit bone health. Activities that involve impact, when appropriate for the individual, can also provide a stimulus to bone. Depending on your health, injury history, and bone density, that might include:

• Brisk walking

• Stair climbing

• Hiking

• Jogging

• Jumping or hopping exercises

• Sports and recreational activities

  
  

But more impact isn't automatically better. If you already have osteoporosis, a history of fractures, significant pain, or another medical condition affecting your bones, your exercise program may need to be modified. This is where individualized exercise prescription matters, and physical therapy can give you just that.

3. Balance is part of bone health

Here's an important piece that can sometimes get lost in the conversation about bone density: Strong bones are only part of the equation. Falls are a major pathway to fractures. That's why balance, strength, coordination, mobility, and confidence with movement all matter. A well-designed physical therapy program can address things like:

• Lower-body strength

• Single-leg balance

• Walking mechanics

• Core and hip strength

• Reaction time

• Mobility

• Confidence with stairs and uneven surfaces

In other words, we're not only trying to make your bones stronger, we're also helping you become more capable and resilient in your everyday life.

4. Don't forget nutrition

Exercise is only one part of the picture.Your body needs adequate energy and nutrients to support your bones, muscles, and overall health. Calcium and vitamin D are particularly important for bone health, and adequate overall nutrition is important when you're exercising regularly. Smoking and excessive alcohol consumption can also negatively affect bone health. If you're unsure whether your diet is meeting your needs, talk with your physician or a registered dietitian rather than relying on supplements or social-media recommendations.

What should you actually do?

Instead of asking only: “Do I need a DEXA scan?” it may be more useful to ask:

“What am I doing right now to maintain strong bones and reduce my risk of injury?” For many women, the answer can start with a few simple things:

• Move regularly. Your bones and muscles benefit from regular physical activity.

• Strength train. Progressively challenging your muscles also provides an important stimulus to your bones.

• Work on balance. Reducing fall risk becomes increasingly important as we age.

• Fuel your body. Adequate calories, calcium, vitamin D, and overall nutrition support bone and muscle health.

• Know your risk factors. Talk with your physician about whether your personal history warrants earlier bone-density screening.

• Don't wait for a diagnosis to start exercising. Bone health is something you can work on throughout your life.

  
  

The bottom line

The conversation around menopause and bone health is changing, and that's a good thing. But you don't need to panic about your bone density or automatically schedule a DEXA scan because you turned 40 or entered menopause. Instead, think of bone health as part of your overall physical health. Your heart benefits from exercise. Your muscles benefit from exercise. Your balance benefits from exercise. And your bones benefit from being challenged, too. If you're unsure how to safely begin or progress a strength, impact, or balance program, that's exactly where a physical therapist can help. Your bones don't need you to be perfect. They need you to keep moving.