Bone density is a critical, but often overlooked, component of women’s health.
For many women, bone health only becomes a focus after a fracture or an osteoporosis diagnosis. But by the time these events occur, significant bone loss has likely already taken place, and fractures in particular carry real risks of morbidity, prolonged recovery, and an uncertain return to prior function.
This is what makes early detection so important.
Most people hit their peak bone mass, or maximum bone size and strength, between the ages of 25 and 30. Around age 40, bone density declines gradually over time, often without symptoms [1]. And while osteoporosis is commonly associated with aging, the process that leads to it frequently begins decades earlier.
An estimated 44 million Americans have low bone density, which increases their risk for osteoporosis [2]. Women are disproportionately affected, accounting for up to 80% of cases—and as many as one in two women over age 50 will experience a fracture or broken bone related to bone loss in their lifetime [3] [4].
Bone health is directly related to long-term mobility, independence, and quality of life. The question is no longer whether bone density matters; it’s whether we’re measuring it early enough to change long-term outcomes.
What is bone density and how is it measured?
Bone density refers to the amount of mineral content within bone tissue - essentially, a measure of bone strength [5].
The most common way to assess this is through a bone density test, typically performed using a DEXA scan. This imaging technique evaluates bone mineral density at key sites such as the hip and spine, where fractures are most likely to occur [6].
Results are usually reported as:
Normal bone density
Osteopenia (early-stage bone loss)
Osteoporosis (more advanced bone loss with higher fracture risk)
This classification provides a snapshot of bone health at a single point in time. But its value increases significantly when interpreted alongside other important factors, including your age, genetics, hormonal status, body composition, and lifestyle habits.
Why are women at higher risk for low bone density?
Women face a higher risk of low bone density due to a combination of biological and hormonal factors.
In general, women tend to have smaller, thinner bones than men [4]. They also reach a lower peak bone mass earlier in life and begin losing bone at a younger age [7].
Hormonal changes play a key role in bone development and bone loss. Estrogen may be the most important, as it helps maintain bone strength. As estrogen levels begin to decline in perimenopause, which can occur up to 10 years before menopause, bone loss accelerates - especially in the absence of resistance training, high-impact exercise, nutritional support (namely calcium and vitamin D), and hormone replacement therapy (for those eligible).
One study suggests that women lose on average 1.8-2.3% of bone loss in their lumbar spine and 1.0-1.4% in their hip during late perimenopause or early postmenopause [8].
Yes, low bone density is often described as a “silent condition” because it typically doesn’t come with noticeable symptoms. Most people don’t know these changes are occurring in their bone density until a fracture or full break occurs.
By the time osteoporosis is diagnosed, significant bone loss has likely already occurred, emphasizing the need for early detection. A bone density test allows for intervention at a stage when changes can meaningfully impact the trajectory of bone loss – before fracture risk rises and structural compromise becomes harder to reverse.
Osteopenia vs. osteoporosis
Understanding the difference between osteopenia and osteoporosis is key to early intervention.
Osteopenia describes a reduction in bone density that is not yet severe enough to be classified as osteoporosis [9]. Osteopenia can be reversible; it’s often considered a warning stage and allows you to take action before more loss occurs.
Osteoporosis, on the other hand, reflects more advanced bone loss and is associated with a higher risk of fractures, particularly in the hip, spine, and wrist [10].
The transition between these stages is not always abrupt. It can happen gradually, influenced by lifestyle habits, hormonal changes, genetic predisposition, and medication exposures (like high-dose or long-term corticosteroid use).
When should women start testing for bone density?
Current guidelines often recommend bone density testing starting at age 65, or earlier in women with specific risk factors [11].
But this approach may miss an important window. Bone loss often begins earlier than these guidelines account for, particularly during the years leading up to menopause. For many women in their late 30s, 40s, and early 50s, bone density is not routinely assessed, despite significant changes that may already be underway, creating a gap between when bone loss begins and when it’s detected.
Earlier baseline testing allows for:
Identification of low bone density before fracture risk significantly increases
More targeted, personalized intervention strategies
The ability to track changes over time
Maintaining bone density is critical for long-term functional fitness, and it preserves the ability to safely perform everyday activities such as climbing stairs or traveling with luggage without the high risk of fracture.
Research consistently shows that high-intensity and high-impact exercise, such as running and HIIT, can help enhance bone mineral density, but combined approaches incorporating both impact training and resistance training outperform either modality alone [12]. That’s because there are specific mechanical thresholds for bone adaptation, and different types of exercises impact site-specific bones differently [13] [14]. Without these forms of movement, bone density may be at risk of declining. That’s why, in some cases, even former elite athletes can have low bone density.
Meghan Musnicki, a professional rower, four-time U.S. Olympian, and two-time Olympic champion, ensures she’s leaning into a lower rep range with heavier loads to maximize muscle growth, which is critical for supporting bone density during perimenopause. She also modifies her movements to reduce injury risk.
“You can max out your engine, raise your threshold, and build muscular strength and endurance, but if your bones can’t support it, performance has a ceiling,” says Musnicki. “I’ve also realized that while our needs change, age isn’t a limitation. It’s just an invitation to train with more purpose and strategy.”
Consider a Biograph member in her early 30s who joins, intending to be proactive rather than reactive about her health.
She is a marathon runner, exercises regularly, and has no symptoms. Under traditional care, bone density testing wouldn’t typically be recommended.
But a DEXA scan reveals low bone density in the hip. This finding is unexpected, but she can likely reverse this result.
Further evaluation suggests that while her cardiovascular fitness is strong, her exercise routine lacks the type of loading required to support optimal bone adaptation.
With this insight, her care plan is adjusted to include:
Progressive strength training
Plyometric and multidirectional movement
Nutritional strategies to support bone health
Over time, these changes can be tracked to see how her bone density improves.
Why bone density matters for long-term health
Bone density is directly tied to long-term mobility and independence, and is a foundational component of longevity.
Fractures, particularly in the hip and spine, can have significant downstream effects, including reduced mobility, loss of independence, increased risk of other health complications including higher rates of both short-term and long-term mortality.
For women, the lifetime risk of fracture due to osteoporosis exceeds that of heart attack, stroke, and breast cancer combined [15].
At Biograph, bone density testing through a DEXA scan is integrated into a broader assessment that includes body composition, metabolic health, and physical performance metrics. This allows for a more complete understanding of how different systems are changing over time, and gives clinicians insight into how to intervene effectively.
The bottom line
Bone density is often treated as a late-stage concern, but in reality, it should be viewed as a wake-up call.
Bone loss begins earlier than most women expect, and it progresses silently. By the time it’s detected through symptoms or a fracture or full break, that’s a sign that significant bone density decline has already occurred.
Early detection reverses that trajectory. It allows for intervention when bone health is still modifiable and when lifestyle changes are most likely to be effective.
For women focused on long-term health, performance, and longevity, bone density is not something to measure later. It’s something to understand now.
Common questions about bone density
What is a bone density test, and how is it done?
A bone density test, most commonly a DEXA scan, is a non-invasive imaging test that measures bone mineral density at key areas such as the hip and spine. It’s quick, painless, and provides insight into fracture risk.
Can you have low bone density without symptoms?
Yes. Low bone density typically doesn’t cause symptoms until a fracture occurs. This is why it is often referred to as a “silent condition.”
When should women start testing bone density?
While standard guidelines recommend testing later in life, earlier baseline testing may be beneficial, especially for women interested in proactive health and early detection, or who have a heightened risk of osteoporosis.
What are the early signs of osteoporosis?
Osteoporosis usually develops without symptoms. In some cases, warning signs may include loss of height, changes in posture, or fractures that occur more easily than expected.
How does estrogen affect bone density?
Estrogen helps maintain bone strength by suppressing bone resorption and supporting bone formation. As estrogen levels decline during perimenopause and menopause, bone loss can accelerate, increasing the risk of osteopenia and osteoporosis.
How can women improve bone density?
Bone density can be improved through combined impact or weight-bearing exercise with progressive resistance training and nutritional intervention. The most effective approach depends on your own risk factors, baseline measurements, and the types of exercise that are both safe and sustainable for your body. An informed clinician can help you create a plan that makes the most sense for you and your health needs.
Is a DEXA scan safe for testing bone density?
Yes. A DEXA scan uses low-dose radiation and is widely considered a safe and standard method for evaluating bone density and body composition.
Why does bone density matter for longevity?
Bone density is closely linked to mobility, independence, and quality of life. Maintaining bone strength reduces fracture risk and supports long-term health outcomes.
About the author
Dr. Chen is a Clinic Physician at Biograph NYC. She joined Biograph after building her expertise at the intersection of innovation and academia. Her foundation includes a joint MD and MPH degree from Tulane University School of Medicine and completing both residency and Chief Residency in Internal Medicine at UCLA.
Clinical references
Campbell B. Healthy Bones at Every Age. Aaos.org. Published 2012.
https://orthoinfo.aaos.org/en/staying-healthy/healthy-bones-at-every-age/Bone Health and Osteoporosis Foundation. Osteoporosis Fast Facts.
https://www.bonehealthandosteoporosis.org/wp-content/uploads/Osteoporosis-Fast-Facts-2.pdfBenjamin RM. Bone Health: Preventing Osteoporosis. Public Health Reports. 2010;125(3):368-370. doi:10.1177/003335491012500302
Bone Health and Osteoporosis Foundation. What Women Need to Know. Bone Health & Osteoporosis Foundation. Published 2024.
https://www.bonehealthandosteoporosis.org/preventing-fractures/general-facts/what-women-need-to-know/MedlinePlus. Bone Density. medlineplus.gov. Published May 14, 2024. https://medlineplus.gov/bonedensity.html
National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoporosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Published 2022. https://www.niams.nih.gov/health-topics/osteoporosis
McPhee C, Aninye IO, Horan L. Recommendations for Improving Women’s Bone Health Throughout the Lifespan. Journal of Women’s Health. 2022;31(12). doi:10.1089/jwh.2022.0361
Lo JC, Burnett-Bowie SAM, Finkelstein JS. Bone and the Perimenopause. Obstetrics and gynecology clinics of North America. 2011;38(3):503-517. doi:10.1016/j.ogc.2011.07.001
Varacallo M, Seaman TJ, Jandu JS, Pizzutillo P. Osteopenia. PubMed. Published August 4, 2023. https://www.ncbi.nlm.nih.gov/books/NBK499878/
MedlinePlus. Osteoporosis. Medlineplus.gov. Published May 10, 2024. https://medlineplus.gov/osteoporosis.html
NIAMS Science Communications and Outreach Branch. Bone Mineral Density Tests: What the Numbers Mean. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Published May 5, 2023.
https://www.niams.nih.gov/health-topics/bone-mineral-density-tests-what-numbers-meanManaye S, Kaaviya Cheran, Murthy C, et al. The Role of High-intensity and High-impact Exercises in Improving Bone Health in Postmenopausal Women: A Systematic Review. Cureus. 2023;15(2). doi:10.7759/cureus.34644
Lambert C, Beck BR, Harding AT, Watson SL, Weeks BK. Regional changes in indices of bone strength of upper and lower limbs in response to high-intensity impact loading or high-intensity resistance training. Bone. 2020;132:115192. doi:10.1016/j.bone.2019.115192
Cauley JA, Giangregorio L. Physical activity and skeletal health in adults. Lancet Diabetes Endocrinol. 2020;8(2):150-162. doi:10.1016/S2213-8587(19)30351-1
World Osteoporosis Day 2025 - American Society for Bone and Mineral Research. Asbmr.org. Published 2025. Accessed April 28, 2026. https://www.asbmr.org/advocacy/world-osteoporosis-day-2025
