For as long as I can remember, my mother—whom I resemble closely enough that strangers sometimes treat us like before-and-after photos—has narrated certain facts about herself in the first-person plural, joining us together in a small, unlucky demographic damned by extremely minor curses. We don’t look good in red. We should never wear silver jewelry. One pronouncement surfaced more frequently than the others: We will get osteoporosis. Her mother had it, she would say, and so did her grandmother. Our bones were small, she’d explain. And you never really drank a lot of milk as a child.
Not long ago, an unpleasant but minor stomach condition forced me onto a low dose of a steroid, whose side effects included the remote, theoretical possibility of decreased bone density. In an act of due diligence, my doctor ordered a DEXA scan, an imaging test used to measure bone mineral density and from it extrapolate one’s future fracture risk. I remember little about the actual X-ray, but I’ll never forget the alarm on the face of the specialist charged with interpreting the results a few weeks later.
“You’re 37?” he asked, sounding stricken.
All but two of my vertebrae were within the range of what is considered osteopenia, the clinical term for low bone density, often considered a precursor to osteoporosis. The other two were solidly osteoporotic.
Did I have any children, he wanted to know.
Yes, I told him. One.
He asked if I planned on having any more.
“I’m not sure,” I said. “Probably?”
In that case, he sighed, there was nothing to be done. Until I had birthed and weaned my hypothetical second (and definitely last, I assured him) child, I was not a candidate for any available medications currently on the market, which, like most drugs, have not been tested on pregnant women. He encouraged me to continue taking a calcium supplement and to incorporate strength training into my exercise routine. “Try not to fall,” he added.
In the months that followed, it began to seem like a concern I had long associated with AARP inserts was now a green-juice-adjacent wellness frontier. I walked past multiple boutique fitness studios advertising bone-building workouts and clicked past numerous alarming headlines posted by mainstream publications. At the gym, people were standing on a vibrating platform that looked a bit like a giant hockey puck, ostensibly to strengthen their skeletons while they did their leg lifts. Glossy-haired perimenopause influencers kept popping up on my feed, talking about bone density and the midlife hormonal changes that cause it to plummet.
Endocrinologist Caroline Messer, MD, attributes the surge in awareness to the prevalence of GLP-1s. “With any kind of weight loss, you have an increased risk of bone loss, so I think that’s the main reason we’re hearing so much more about it now,” she says. “The typical screening recommendation is for women 65 and older, and that is just terrible, in my opinion.” More and more doctors, Messer says, are, like her, beginning to screen their patients earlier, at the first signs of an irregular period.
Indeed, by the time osteoporosis is diagnosed—commonly after a broken hip or spine—many years of bone loss have already taken place. Peak bone mass is typically achieved by the age of 30; the higher one’s peak bone density, the more remains later in life to serve as a buffer. For most people, building a kind of skeletal savings account does not require heroic interventions but rather regular, unglamorous habits: adequate calcium and vitamin D, enough protein, and a regular weight-bearing exercise routine. The available drugs, broadly speaking, fall into two classes: ones that slow the rate of bone loss and ones that stimulate new bone formation. These drugs are typically reserved for patients who have crossed the diagnostic threshold of osteoporosis.
But we may be on the brink of a new era in preventative treatment. There is promising new research that looks at a “biological switch,” normally triggered by exercise, that helps keep bones strong—offering a potential path for drugs that might mimic physical activity. New screening technologies (based on bone flexibility rather than mineral density) may be able to catch issues earlier than before. And in 2024, the FDA cleared the Osteoboost, a new wearable device for osteopenia. Fitted like a belt, it delivers vibration to the hips and lower spine. Bone is constantly renewing itself, spurred on by specialized cells that break down old bone while other cells build new mineral in its place. Those cells are highly responsive to mechanical stress—the reason weight-bearing exercise strengthens the skeleton—and the device is designed to imitate that signal through subtle vibration.
“More women die of hip fractures than breast cancer,” says Laura Yecies, a grandmother of six and Osteoboost’s CEO. Yecies thinks that low-bone-density awareness has suffered from what she calls “double discrimination.” It is a condition that disproportionately affects women, yes—but she also believes women themselves tend to minimize it. “It’s common that older women get osteoporosis,” she says. “In fact, almost all women will. But it also used to be inevitable that people would get high blood pressure.”
“Fear is a wonderful motivator,” says Steven R. Goldstein, MD, a New York–based gynecologist and professor at NYU who has treated menopausal women for decades. “My patients are all really good about their breasts,” he said. “They get their mammograms and ultrasounds every year. I wish everyone were as focused on their bone health.” The statistics are indeed terrifying: 21 percent of older women who fracture a hip die within a year, and 25 percent don’t ever live independently again. Goldstein conceded that these numbers tend to refer to people much older than me, but still I was right to feel dread.
Dread is what finally forced me to start a weight-bearing exercise routine. Dread and the fact that a new outpost of Good Day Pilates opened a half block from my Brooklyn apartment. Founded by Clara Gilmour, a physical therapist, the studio offers classes that incorporate heavy resistance bands and the occasional kettlebell to provide what Gilmour calls, appealingly, a “strengthening dose.” For someone like me, she says, a classical balletic Pilates class with a lot of stretching might not be sufficient. “You want to work the muscles in a way that actually pulls on the bone and stimulates new growth. You need to work to the point of fatigue, where the muscle—and the bone—actually respond.”
So now I go three, sometimes four, days a week. Besides its extreme proximity, I like that the studio has no mirrors and I am able to convince myself that taking a class is a nonnegotiable sort of medicine.
Is it working? I might not know for decades, but wanting a second opinion—or perhaps just reassurance that I wasn’t already halfway to collapsing into a pile of dust—I call David Karpf, MD, an endocrinologist at Stanford who specializes in metabolic bone disease.
“I really wish every woman had a baseline DEXA scan taken before menopause,” he tells me. The test itself, he explains, is an imperfect instrument, especially for people whose bones, like mine, are smaller than average.
“Let’s calculate your fracture risk right now,” he suggests, rattling off a list of rapid-fire questions. What was my height, my weight, my age? When did I start menstruating? Had my mother or father ever fractured a hip? Had I ever broken a bone? I could hear him typing figures into a calculator on the other end of the line.
He reads the results aloud. “You have a 99.2 percent likelihood of not having a hip fracture in the next 10 years.”
What my earlier scan had probably captured, Karpf explains, was simply the natural consequence of having small bones. “In all likelihood, this is a good representation of your peak bone mass,” he said.
It was just one opinion, but I hung up the phone and was tempted, if I’m being honest, to cancel my upcoming Pilates class. But that was not the point. Even if the story my mother told was maybe not quite as inevitable as it sounded, I should do everything in my power to offset this folkloric family hex. So I continue to drag myself to Pilates and swallow a calcium supplement with my coffee. And one day soon I will probably purchase an Osteoboost belt, which will rumble at the base of my spine as I make my way to pick up my daughter at day care, to which I have begun to bring a sippy cup of milk.