Osteoporosis doesn't start at 50
- Skye Sunderland
- 11 hours ago
- 9 min read
Most women are led to believe that osteoporosis is something to worry about later in life.
Something that "just happens" around menopause or after the age of 50. But the reality is very different.
Osteoporosis doesn’t begin at 50.
It starts decades earlier, often without symptoms, while women are trying to be "healthy" by dieting, skipping meals, or overtraining with cardio.
It begins in your 30s, even earlier.
And here’s what makes it even more important for women: 80% of people with osteoporosis are women. That means you're already more vulnerable, simply because of your biology.
Lower peak bone mass, hormonal fluctuations, pregnancy, breastfeeding, and menopause all play a role in why women are at greater risk than men—and why you must start prioritizing your bone health now, not later.
The choices you make today about your training, your food, your recovery, and your hormones are shaping your skeletal strength for the rest of your life.
Your habits determine if you get osteoporosis at 50—or not.
And if your mother or grandmother has osteoporosis, consider this your wake-up call—up to 80% of bone density is genetically determined, meaning your peak bone mass and how quickly you lose it later in life can be strongly influenced by your parents.
Approximately 1 in 3 women over the age of 50 will be diagnosed with osteoporosis.
But you don't have to be a statistic.
Peak Bone Mass is Your 'Savings Account'
Women reach their peak bone mass by around age 25 to 30. After this, bone building slows down, and bone breakdown (resorption) begins to outpace it. This is a normal part of aging, but the rate of loss can be drastically accelerated by lifestyle factors like:
Prolonged low-calorie dieting
Low protein intake
Lack of resistance training
Hormonal imbalances
Stress
Peak bone mass is essentially your "bone savings account." The more you build early in life, the more you have to draw on later when natural bone loss begins. If you enter your 40s with already low bone density due to under-fueling, poor nutrition, and a lack of strength training, you’re entering midlife with a deficit.
The consequences? Increased risk of osteopenia, osteoporosis, and fractures that can drastically reduce your quality of life.
The Hidden Cost of Diet Culture
Many women enter their peak bone-building years—typically the late teens through their 30s—under the influence of pervasive diet culture. The relentless pursuit of a smaller body, obsession with scale weight, and fear of "bulking up" from resistance training can have a profound, and often invisible, impact on lifelong skeletal health.
While the social cost of restrictive eating may be visible, the physiological toll is often hidden until decades later. At the heart of this issue is Low Energy Availability (LEA)—a state in which the body is not receiving enough energy (calories) to support both exercise demands and basic physiological functions such as hormone production, bone remodeling, and cellular repair. Critically, LEA can occur even in women who are not intentionally dieting. A woman training intensely several times a week, skipping meals, or simply underestimating her energy needs may already be experiencing the consequences.
Relative Energy Deficiency in Sport (RED-S) is the broader clinical framework used to describe the systemic impacts of LEA. Originally observed in athletes, RED-S is now recognized to affect any active woman—regardless of her level of performance or intent. This syndrome doesn't just impair menstrual function and metabolism; it compromises immune health, protein synthesis, cardiovascular function, and—importantly—bone integrity.
One of the earliest and most telling signs of RED-S is amenorrhea, or the absence of menstrual periods. Menstrual irregularities are a red flag that the hypothalamic-pituitary-gonadal (HPG) axis is downregulating reproductive hormones in response to perceived energy scarcity. Among these hormones, estrogen plays a central role in maintaining bone density by inhibiting bone resorption (breakdown) and promoting bone formation. When estrogen levels drop—whether due to intense training, inadequate nutrition, or a combination of both—the bones silently suffer.
Over time, low protein and calcium intake further exacerbate this issue. Both nutrients are essential for the continuous process of bone remodeling. Protein provides the building blocks for collagen—a major component of bone matrix—while calcium is required for mineralization and structural strength. Inadequate intake, especially when paired with energy deficiency, compromises the body’s ability to maintain or repair bone tissue, even in young, otherwise healthy women.
What often begins as a "clean eating" phase or a period of high-volume cardio can set the stage for early-onset osteopenia or osteoporosis, even before menopause begins. Alarmingly, bone loss is often silent until a fracture occurs or a scan later in life reveals irreversible damage. The years when bones are meant to reach their maximum density can instead become years of hidden deterioration—something no diet or detox can undo.
The Acceleration Point in Bone Loss
While bone loss begins subtly in a woman’s mid-30s and gradually progresses throughout the 40s, menopause marks a sharp inflection point—a critical acceleration in the rate of bone demineralization. This is largely due to the decline in estrogen, a hormone that plays a central role in maintaining skeletal integrity.
Estrogen regulates bone remodeling—a dynamic process in which old bone is continuously broken down by osteoclasts (bone-resorbing cells) and replaced by new bone formed by osteoblasts (bone-building cells). Under normal hormonal conditions, this cycle remains in balance. However, when estrogen levels fall during perimenopause and menopause, the rate of bone resorption begins to outpace bone formation, creating a net loss in bone mass.
Studies show that women can lose up to 20% of their total bone mass within the first 5 to 7 years after menopause—a staggering figure that underscores the biological urgency of this transition. This bone loss is not evenly distributed across the skeleton. Instead, it disproportionately affects the trabecular (spongy) bone found in areas like the spine, hips, and wrists, which are more metabolically active and more vulnerable to rapid deterioration.
These structural changes aren’t just a matter of density—they also compromise the microarchitecture of the bone, reducing its strength and resilience. The clinical consequences are severe. Hip fractures, in particular, are associated with a marked decline in quality of life, long-term disability, and even increased mortality—with some studies showing up to a 20–30% mortality rate within one year of a hip fracture in older women.
Statistically, 1 in 2 women over the age of 50 will suffer an osteoporosis-related fracture in her lifetime. This isn’t just a matter of aging—it’s the legacy of decades of silent bone loss that often began well before menopause ever started.
But this trajectory is not inevitable. With the right knowledge, intervention, and support, bone loss can be significantly slowed—and in some cases, even partially reversed.
The best time to protect bone health is during the years leading up to menopause—when estrogen is still present, and the remodeling balance can be influenced with training and nutrition.
But if that window has passed, the second-best time is now.
What Builds and Maintains Bone
1. Resistance Training
Bones are living tissue. They adapt to mechanical stress. Progressive, heavy resistance training is the most powerful non-pharmaceutical tool to preserve and build bone mass.
Exercises like squats, deadlifts, overhead presses, and weighted carries load the spine and hips—key areas affected by osteoporosis.
Impact training (jumping, bounding) can also be beneficial when appropriate.
The LIFTMOR study showed that postmenopausal women who lifted heavy 2x/week increased bone density, posture, and strength with no increased risk of injury.
2. Protein Intake
Protein is essential for bone remodeling. Bone is made of a protein matrix (mostly collagen), which minerals like calcium deposit into.
Aim for 1.6 to 2.2g of protein per kg of body weight daily.
Adequate protein improves calcium absorption, supports muscle mass, and reduces fracture risk.
3. Calcium and Vitamin D
Women need around 1000–1300 mg of calcium daily, ideally from food sources (dairy, leafy greens, fish with bones) and/or supplements.
Vitamin D is essential for calcium absorption and bone metabolism. Blood levels should be checked, and many women benefit from supplementation, especially in low-sunlight months.
4. Hormonal Health
Estrogen is critical for bone protection. Loss of menstruation (amenorrhea) due to low energy availability or overtraining is a red flag.
During perimenopause and menopause, bone loss accelerates without hormone therapy or other interventions.
Cortisol, the stress hormone, also negatively impacts bone density over time.
What Puts You at Higher Risk?
While all women will experience some degree of bone loss during and after menopause, some are more vulnerable than others. Genetics, lifestyle choices, medical history, and previous health behaviors can all compound the risk. Understanding these factors is essential—not only for early identification but also for strategic intervention.
Bone health is not determined overnight; it is the outcome of decades of accumulated habits, exposures, and biological influences. If you or your clients fall into one or more of the following categories, it's a signal to take proactive steps now, before more serious consequences arise.
1. Family History of Osteoporosis or Fractures
A family history of osteoporosis or fragility fractures, particularly in a parent or sibling, significantly increases your own risk. Studies show that genetics account for up to 80% of variance in peak bone mass, meaning that even with a healthy lifestyle, your genetic blueprint can predispose you to lower bone density.
2. History of Eating Disorders or Restrictive Dieting
Women who have previously suffered from anorexia, bulimia, or chronic restrictive eating are at much higher risk of low bone mineral density, even years after recovery. This is largely due to long-term suppression of sex hormones and inadequate nutrient intake, especially calcium and protein, during crucial bone-forming years.
3. Missed or Irregular Periods
Amenorrhea (missing periods for 3 months or more) or chronic cycle irregularity is often a sign of low energy availability (LEA) or hormonal dysregulation. Whether due to stress, overtraining, PCOS, or under-fueling, irregular cycles mean disrupted estrogen production—and without sufficient estrogen, bone turnover becomes imbalanced. Even teenagers and young adult women who miss their periods can already be experiencing bone loss.
4. Sedentary Lifestyle or Lack of Resistance Training
Bones adapt to the forces placed upon them. Without regular weight-bearing or resistance exercise, bones lose both density and strength. In fact, women who are inactive can lose bone mass at a rate of 1–3% per year after menopause, compared to those who engage in strength training, who often maintain or even improve their bone density.
5. Smoking or Excessive Alcohol Use
Both smoking and high alcohol intake have direct negative effects on bone cells. Smoking reduces blood flow to the bones, impairs calcium absorption, and interferes with estrogen production. Alcohol in excess (>2 drinks/day) has been shown to suppress osteoblast function and increase risk of falls—doubling the threat to skeletal health.
6. Low Body Weight or Very Lean Body Composition
While being lean is often viewed as a health goal, excessively low body weight (BMI under 18.5) is associated with lower bone mass and greater fracture risk. This is due in part to lower estrogen production and reduced mechanical load on the skeleton. Athletes with extremely low fat mass or low energy availability are particularly vulnerable.
7. Chronic Use of Certain Medications
Certain medications are known to weaken bone over time. These include:
Corticosteroids (e.g., prednisone), used for autoimmune or inflammatory conditions
Proton pump inhibitors (PPIs), which can reduce calcium absorption
Some anticonvulsants and chemotherapy agents
Aromatase inhibitors, used in breast cancer treatment, which dramatically reduce estrogen
If any of these factors apply to you—or to your clients—it’s a strong indicator that bone loss may be occurring silently and action should be taken. This doesn't mean panic. It means strategic prevention.
How to Build Bone Now (Not Later)
Follow these steps for a strategic prevention plan:
1. Lift heavy weights at least 2x/week. Focus on compound movements that load your spine and hips. Those 5kg weights in your Les Mills class DO NOT CUT IT.
2. Eat enough. Make sure you're fueling your workouts and not chronically under-eating.
3. Prioritize protein. Every meal should contain a quality protein source.
4. Track your cycle. Missing periods is a signal your hormones (and bones) are under stress.
5. Get outside. Soak up vitamin D or supplement if needed.
6. Add calcium-rich foods. Yogurt, sardines, leafy greens, almonds, and tofu are all great options.
7. Manage stress. Chronic high cortisol suppresses bone-building and can worsen hormone imbalances. Perform breath-work, meditation, or journal.
Bone health is about more than avoiding fractures. It's about quality of life. It's about being able to travel, lift your grandkids, garden, hike, move with freedom and independence well into your 70s, 80s, and beyond.
And it starts now. Not later.
Osteoporosis is preventable. But only if we stop treating it like something that magically appears at 50. Your bones respond to what you do every day—how you eat, how you move, how you manage stress, and how you support your hormones.
Don’t wait until menopause to care about your bones. Don’t wait until your first fracture.
Because Osteoporosis starts before 50, and it depends on YOUR habits.
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