The 8 Pillars of Unbreakable Bones: What Every Woman Over 40 Needs to Know Before Menopause

**Dr. Vonda Wright** (0:00)
Why should 40-year-old women be concerned about their bone health? Is an osteoporosis something happens to little old ladies who fall down off a curb and break their hip? Well, let's think about that a minute. Bone and bone disease is a concern for us across our lifespan. And while you may recognize fracture as the telltale sign of poor bone quality, or force that overcomes the strength of our bone, the reality is that our bone health begins as teenagers. Let's walk through the lifespan of bone health and why 40-year-olds need to be really concerned about this. In fact, I would venture to say there's about a five-year window when we have to get in front of this. So what happens with our bones?
Once we hit puberty and we come into our estrogen and our growth plates are wide open, we are building bone rapidly. And it is estimated that we reach peak bone mass before we reach 30 Between about 15 and 28, we are building the best bone. During that time, we therefore need to be exercising, building muscle, jumping around, building bone. We need to be metabolically healthy. And if we're doing that, that's just amazing. We're going to max our bone density and start out at a really good place. But here's what I see. I do bone densities on almost everybody that comes to me.
And it is not uncommon for me to see young women with low Z scores and low T scores. And I'll explain to you what that means. How could that be that young, healthy-ish women have trouble with their bones already? Well, I can think of a few reasons. Number one, maybe we're back to thinking of women as only valuable when they're this skinny. Skinny, skinny, skinny with low muscle mass. I thought we were getting past that we were reaching a place where strong young girls was the mantra. But what I see now is some inkling returning to skinny. I'm just going to say to you that unless we build bone and muscle in our youth, we are going to start out into our adult life at a vulnerable place.
Maybe girls are just not building enough. Or number two, what if we are such a digital culture, we're just not active enough?
It's not that we're just not eating enough and we're skinny, but maybe we're not active enough and bashing our bones or building muscle. I can see that happening because we are a sedentary digital society. Or what about the third category? Maybe our young girls are really active, burning thousands of calories on the soccer pitch. But like so many of the athletes I've taken care of over the years, their refueling is with gummy worms. So we're exerting a lot of energy, but we're not feeding, and we're in relative energy deficiency. In that category of girls, sometimes we do not see periods for 6 to 9 months.
That's the way it was for me. I was a ballet dancer, and at the time, I didn't know any better. I thought, oh, good for me.
I'm not having periods, none of that annoying stuff. But the reality is, healthy normal periods signal healthy normal hormones, and therefore building muscle and bone.
So it is not okay for our bodies to skip periods because of relative energy deficiency syndrome. Those are all the reasons, or many of the reasons I can think of, that young girls are not building enough bone. So we reach peak bone mass, hopefully as high as we can, but we reach it, and then around 30, we're losing bone at a rate of about 1% per year, until we start the hormonal fluctuations of early perimenopause. You don't feel it in your bones. You do not feel the hormonal fluctuations in your bones and your muscles. What you may feel is sleepless nights. What you may feel is brain fog, night sweats. What you may feel is not feeling like yourself, but at the very same time that you are not feeling like yourself, what's happening to your bones can become catastrophic. We go from losing 1% of our bone a year to up to 3% once estrogen levels start dropping, or estrogen walks out the door. On top of that, there's new data that shows that as estrogen declines and a hormone called FSH rises, they have independent negative effects on bone health. So that over the course of perimenopause, with the most rapid bone loss in the 2 to 3 years around menopause, you can lose 20% of your bone density. So if we're starting out at a low level, because we never built enough as a young girl, and then we're declining rapidly, we will reach midlife without even knowing it, with a bone deficit. So that's why I say that there is this critical window for getting in front of our bone health, and why I think it's really important for 40-year-old women. It's finally a birthday that's got enough candles on your birthday cake to burn down your kitchen. That is the time we must notice. So how are you going to do that? Well, go get a DEXA scan. DEXA scans are dual x-ray technology that will tell you your bone mineralization. Or calculate your FRAX score. If you Google FRAX, F-R-A-X, a website comes up. And it will help you estimate your fracture risk. Or if you're lucky enough to have access to trabecular bone scores via ultrasound, which is becoming more popular in the United States, let's figure out how strong your bones are on the inside. Even at 40, these data are critical because what happens if we wait until we're 50? We could have lost 20% of our bone density.