Are Your Hormones Putting Your Bones at Risk?

When we think about the impact of hormones in midlife, symptoms like hot flashes, mood swings, weight gain, and fatigue often take center stage. But one of the most serious and silent consequences of declining estrogen, progesterone, and testosterone is bone loss—a risk that doesn’t usually show up until a woman experiences a fracture.

Your bones may seem like a solid, unchanging structure, but they are dynamic tissues that are constantly remodeling—breaking down and rebuilding. This delicate balance is heavily influenced by hormones, which is why menopause significantly increases the risk of osteopenia (low bone mass) and osteoporosis (fragile bones prone to fractures).

If you’ve recently had a DEXA scan that showed signs of bone loss, or you’re wondering how to protect your skeletal health in midlife, keep reading. We’ll cover:

✅ When to get a baseline DEXA scan
✅ Why estrogen, progesterone, and testosterone matter for bone health
✅ What to do if a DEXA scan reveals osteoporosis or osteopenia
✅ The risks and benefits of osteoporosis medications
✅ How to build stronger bones—without just relying on drugs

When Should You Get a Baseline DEXA Scan?

A DEXA scan (Dual-Energy X-ray Absorptiometry) is the gold standard for measuring bone mineral density (BMD). The standard medical recommendation is to get a DEXA scan at age 65—but waiting that long is a huge mistake for many women because the “horse is out of the barn” by that time!

👉 You should consider getting a baseline DEXA scan at age 50 (or earlier) if you have risk factors for bone loss.

Who Should Get a DEXA Scan Before 65?

✔️ Women over 50, especially postmenopausal
✔️ Anyone with a history of fractures after age 40
✔️ Women in early menopause (before age 45)
✔️ Those with a family history of osteoporosis
✔️ Anyone who has used steroids (like prednisone) long-term
✔️ Women with thyroid disorders, celiac disease, or autoimmune conditions
✔️ Thin or small-framed women (low body weight is a risk factor!)

By getting a baseline scan at 50, you can catch early bone loss and take action before you develop osteoporosis. If your scan is normal, you may not need another for several years. But if osteopenia or osteoporosis is detected, you can start interventions immediately to prevent fractures down the road.

Hormones and Bone Health: The Critical Connection

Estrogen: The Bone Protector

Estrogen plays a key role in preventing bone breakdown by slowing the activity of osteoclasts—cells that break down old bone. When estrogen levels drop during perimenopause and menopause, bone resorption (breakdown) accelerates, and new bone formation can’t keep up. The result? Rapid bone loss that increases the risk of fractures.

Progesterone: The Bone Builder

Progesterone stimulates osteoblasts—the cells responsible for laying down new bone. Without enough progesterone, your ability to form new bone tissue declines, making it harder to replace what’s being lost. This new tissue helps keep bones “bendy” and able to withstand significant impact without breaking.

Testosterone: More Than Just a “Male Hormone”

Testosterone supports bone formation, muscle strength, and stability. Low testosterone levels in women can contribute to frailty, muscle loss, and increased fall risk, which leads to fractures.

What to Do If a DEXA Scan Shows Osteoporosis or Osteopenia

If your DEXA scan shows osteopenia (T-score between -1.0 and -2.5) or osteoporosis (T-score below -2.5), don’t panic. There are many proven, science-backed ways to strengthen your bones before resorting to medication.

Step 1: Optimize Your Hormones

Since hormone loss is a primary driver of bone loss, restoring hormonal balance can be a powerful intervention. Options include:

• Bioidentical Hormone Replacement Therapy (BHRT): Estrogen therapy can slow bone loss and reduce fracture risk—but it works best when started within 10 years of menopause. Micronized progesterone can also support bone-building.
• Testosterone Therapy (if indicated): If blood tests show low testosterone, replacing it can improve bone strength and muscle mass, reducing fall risk.

Step 2: Strength Training & Impact Exercise

• Strength training 2-3 times per week (squats, deadlifts, resistance bands). I recommend working with a trainer at first to make sure your form is good which will decrease the likelihood of injury.
• Weight-bearing activities like walking, hiking, dancing, and stair climbing
• High-impact exercises (if safe for you), like jumping or plyometrics, stimulate bone growth

Step 3: Optimize Nutrition for Bone Strength

• Calcium (but not too much!): 1,000-1,200 mg/day, preferably from food (leafy greens, dairy, almonds)
• Vitamin D: Essential for calcium absorption—2,000 IU/day or test your levels. An ideal level is between 50-70.
• Magnesium: Works with calcium to build bone—found in nuts, seeds, dark chocolate. Vitamin D depletes magnesium, so don’t skip this!
• Vitamin K2: Directs calcium into bones instead of arteries (found in fermented foods, grass-fed dairy)
• Collagen & Protein: 100g+ protein daily supports bone matrix

Step 4: Lifestyle & Fall Prevention

• Avoid smoking and excessive alcohol
• Prioritize sleep—bone remodeling happens at night!
• Improve balance and stability with yoga, Pilates, or tai chi

The Truth About Osteoporosis Medications: Risks vs. Benefits

Doctors often push medications for osteoporosis, but many come with serious risks:

💊 Bisphosphonates (Fosamax, Boniva, Reclast)

• Reduce fracture risk short-term, but long-term use can cause “frozen bone”—brittle bones that increase fracture risk.
• Side effects: Jawbone decay, esophageal irritation, and atypical fractures.

💊 Prolia (Denosumab)

• Can increase bone density, but bone loss rebounds sharply after stopping.
• Risk of severe fractures after discontinuation.

💊 Forteo & Tymlos (Anabolic Therapies)

• Stimulate new bone growth but require daily injections and are expensive.
• Only approved for 2 years—not a long-term solution.

Should You Take Medication?

• If you have severe osteoporosis (T-score -3.0 or lower) or fractures, medication may be necessary in the short term.
• If you have mild osteopenia, focus on hormones, nutrition, and strength training before considering meds.

Final Thoughts: Take Action Today

Bone loss isn’t inevitable—but protecting your skeleton requires a proactive approach. The best strategy? Support your hormones, build strength, and nourish your body. If you’ve had a concerning DEXA scan, don’t settle for a prescription without exploring all options.

💡 Need help optimizing your hormones and bone health? Let’s talk. My team can work with you to create a customized plan to keep you strong for life! Schedule that here: www.drannagarrett.com/lets-talk