Bone Health
A practical guide to bone density, screening and evaluation, and how you can best support your bone health.
Bone health is foundational to mobility, independence, and long-term wellbeing. Most people think of bones as static scaffolding, but bone is living tissue that is constantly remodeled. When bone breakdown outpaces formation, bone density falls, and fracture risk rises. Bone strength changes across life, often without symptoms until a fracture occurs.
What to know about bone health
- Osteopenia means your bone density is lower than expected, while osteoporosis involves more bone loss and a higher fracture risk. Your doctor may use a DXA scan and your fracture history to help decide on next steps.
- Your healthcare provider may review your fracture history, family background, medications like glucocorticoids, hormone levels, nutrition, and any conditions that affect how your body absorbs nutrients or builds bone.
- Getting enough calcium, vitamin D, and protein, along with safe weight-bearing and resistance exercises, balance training, and fall prevention, can all help keep your bones healthy.
- Some people may need prescription medicines. If you are taking denosumab or another osteoporosis treatment, do not stop without talking to your doctor. Supplements cannot replace treatments meant to prevent fractures.
Bone mineral density, osteopenia, and osteoporosis
Bone mineral density (BMD) is a measure of how much mineral (mostly calcium and phosphate) is packed into bone. BMD is expressed as a T-score that compares an adult's bone density to a young, healthy reference.
Osteopenia describes bone density that is below normal levels but not low enough to be classified as osteoporosis. It indicates increased risk for future bone loss.
Osteoporosis, which means “porous bones”, is marked by substantially reduced bone density and microarchitectural changes that increase the risk of fragility fractures. Osteoporosis can eventually make bones so brittle that they break from small stresses like coughing and bending. One out of every two women, and up to one in four men, will have a fracture due to osteoporosis in their lifetime. Over 2 million fractures each year in the U.S. are due to osteoporosis.
Osteopenia and osteoporosis are diagnostic categories that help guide monitoring and treatment.
Screening and evaluation
Healthcare providers commonly measure bone mineral density at the hip and spine using dual-energy X-ray absorptiometry (DXA or DEXA). In addition to DXA, fracture risk calculators (such as FRAX) combine BMD with clinical risk factors to estimate 10-year fracture risk and guide treatment decisions.
Current guidelines recommend osteoporosis screening with DXA for women aged 65 and older and for postmenopausal women younger than 65 who are at increased risk.
Perimenopausal women can benefit from a baseline DXA scan. Menopause causes significant hormonal changes that often accelerate bone loss. For many women near or just after menopause, baseline bone density tests provide a clear starting point, help estimate fracture risk, and inform timely prevention strategies.
If low bone density or fractures are identified, your provider will typically evaluate for secondary causes. This may include a review of medications (such as long-term glucocorticoids), medical history (early menopause, malabsorption syndromes), and laboratory tests to check calcium and vitamin D status, thyroid function, kidney function, and other relevant markers.
Factors that can affect bone strength
Bone health depends on more than calcium. Factors like age, menopause or other times of low hormones, family history, smoking, low body weight, limited movement, and some long-term illnesses can all affect bone strength. If you have had fractures or falls before, that is also important to consider.
Certain medicines can lead to bone loss or increase the risk of fractures. Long-term glucocorticoid use is one example. Other medicines can also affect your bones, depending on how much you take and for how long. Do not stop taking any prescribed medicine by yourself. Talk to your doctor to review the benefits, possible alternatives, or ways to protect your bones.
Other causes may include health problems that affect hormones, nutrient absorption, or how bones are built and broken down. Your doctor can help decide if you need tests for things like poor absorption or other hidden conditions.
In summary, many different factors work together to affect bone strength:
- Age and sex: Bone mass is highest in early adulthood. As people get older, bone loss can happen faster than the body can make new bone. Women have a higher risk than men, especially after menopause when estrogen levels drop.
- Genetics and body size: Your family history, ethnic background, and low body weight can affect bone strength and your risk of fractures.
- Hormones: Hormones like estrogen, testosterone, thyroid hormones, and others affect how bones are built and broken down.
- Nutrition: Getting enough calcium, vitamin D, protein, and other nutrients helps keep bones healthy.
- Physical activity: Exercises like walking, running, or lifting weights help build bone and improve balance.
- Lifestyle: Smoking and drinking too much alcohol can make bones weaker and raise the risk of fractures.
- Medications and chronic disease: Long-term corticosteroid use, certain antiseizure medicines, and conditions like poor nutrient absorption, inflammatory diseases, or chronic kidney disease can lower bone density.
Everyday support for bones and balance
Healthy lifestyle habits support strong bones and are recommended for everyone, regardless of bone density.
- Nutrition: Try to get enough calcium and vitamin D from your diet, including dairy or fortified plant milks, leafy greens, fatty fish, and mushrooms. Use supplements if you cannot get enough from food, and ensure you get enough protein, which also supports your bones and muscles. Your healthcare provider can assess your nutrient levels and help determine the most suitable supplement plan for you.
- Exercise: Weight-bearing activities (such as walking, hiking, or climbing stairs), resistance training with weights or bands, and balance exercises (such as tai chi or standing on one leg) can help keep your bones strong and lower your risk of falling.
- Lifestyle: Quit smoking and try to limit how much alcohol you drink. Keeping a healthy weight matters, since being underweight can increase your fracture risk.
- Fall prevention: Check your home for safety, get your vision tested, review your medications, and practice balance exercises to lower your risk of falling and breaking a bone.
When treatment may include medication
Healthy habits help keep your bones and muscles strong, but they may not be enough if your fracture risk is high. Based on your DXA scan, fracture history, risk factors, and overall health, your doctor may discuss prescription osteoporosis medicines, including their benefits, risks, and other options.
Your provider will offer a treatment plan tailored to you and may involve your primary care doctor, an endocrinologist, or another bone health specialist. Some medicines require a plan for stopping them safely. For example, do not stop denosumab or any osteoporosis medicine without first talking to your doctor.
Calcium, vitamin D, and other supplements are not a substitute for prescribed medicines or a full plan to prevent fractures. Talk with your doctor about any supplements you take, especially if you use other medicines or have kidney, heart, or digestive problems.
For people with secondary causes of bone loss, treating the underlying condition (for example, optimizing thyroid status or treating malabsorption) is also critical.
When to seek care
Call emergency services for a serious injury, severe pain, inability to bear weight, or symptoms that may indicate another emergency.
Seek prompt medical evaluation if you have:
- A suspected fracture
- Sudden severe back or hip pain
- New difficulty standing or walking
- A loss of height with new back symptoms
Contact your healthcare provider if you have:
- A prior low-trauma fracture (a fracture from a fall from standing height or less)
- A new osteoporosis diagnosis
- Long-term use of medications known to harm bone (such as oral steroids), especially at higher doses or for months to years
- Early menopause, a history of eating disorders, long-term stomach or digestive problems, or other health issues that can cause bone loss
- Risk factors for low bone density
When bone symptoms need prompt attention
For serious injury, severe pain, or an emergency, call 911. Do not delay emergency care to contact the clinic.
- A suspected fracture, especially after a minor fall or ordinary activity, needs prompt medical assessment.
- Sudden severe back or hip pain, new difficulty standing or walking, or inability to bear weight should be assessed urgently.
- Do not stop denosumab or another osteoporosis medicine without a guided treatment plan from your healthcare provider.
How NaturoMedica can support your plan
When you visit NaturoMedica’s Issaquah clinic, we can review your bone-health goals, any family history of fractures, your DXA results, the medicines and supplements you take, your nutrition and activity levels, and other factors that may affect your bone strength.
We can discuss practical questions about your diet, exercise, balance, and what to bring to your next primary-care or endocrinology appointment. Our advice is personalized for you and works alongside standard medical evaluations and any treatments to help prevent fractures.
If you have them, bring your DXA report, a list of your medicines and supplements, and any notes about fractures or falls.
Bone Health FAQs
What is the difference between osteopenia and osteoporosis?
Osteopenia means your bone density is lower than normal, but not low enough to be called osteoporosis. Osteoporosis is more serious and raises your risk of fractures. Your clinician will look at your DXA results, fracture history, and other risk factors together.
Who should be screened for osteoporosis?
Current guidelines recommend that women age 65 and older, and younger postmenopausal women at higher risk, get screened. There is not enough evidence to recommend routine screening for men, but men can still be at risk and should talk to their healthcare provider if they have concerns. Perimenopausal women can also benefit from a baseline DXA scan to inform prevention strategies.
How often should I repeat a DXA scan?
There is no set schedule for everyone. How often you need a DXA scan depends on your last result, your risk factors, your treatment, and whether a new scan would change your care. Your provider can help you decide the best timing.
Can calcium or vitamin D supplements prevent fractures on their own?
Calcium and vitamin D can be part of your plan, but taking supplements alone is not enough to prevent fractures if you need other treatment. The right amount for you depends on your diet and health history. Consult with your provider to learn the best regimen for you.
Can I stop denosumab if I feel well?
Do not stop taking denosumab or any osteoporosis medicine without talking to your prescribing provider first. Some treatments require a plan to stop safely and lower your risk afterward.
Can NaturoMedica support bone health on the Eastside?
NaturoMedica is at 1220 10th Ave NE in Issaquah and serves Sammamish, Bellevue, Redmond, Renton, Kirkland, and other Eastside communities. Our integrative support can work alongside your primary care or endocrinology team.
Medical information sources
This page is for education and does not replace medical advice, diagnosis, or treatment.
Bone healthcare on the Eastside
NaturoMedica is located at 1220 10th Ave NE in Issaquah, WA, and serves Sammamish, Bellevue, Redmond, Renton, Kirkland, and the greater Eastside. Integrative support can be coordinated with your existing primary-care or endocrinology team.
Related services
- Nutrition Counseling — Discuss food-first nutrition and individualized nutrient needs.
- Functional Testing — Consider targeted evaluation when a result can answer a clinical question.
- Women's Health — Discuss bone-health considerations across menopause and later life.
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