How To Reverse Osteopenia
I remember the day I was told I have osteopenia, and to be honest, I was kind of shocked.
Let me give you my personal backstory first. I will be turning 59 this year and have been strength training off and on for most of my adult life. There was a period of time when I was just running and doing Pilates. There have also been periods when I was injured and rehabbing, and couldn’t do full-body lifting workouts: a grade 3 ankle sprain, a frozen shoulder, herniated discs in my lumbar spine, and a couple of other issues.
But overall, I have been active my entire life. I was a runner from age 15 until about 45. I was a personal trainer for over a decade. I have been a physical therapist for over 26 years, and I now coach women in midlife and menopause. I truly thought I was doing everything right and that there was no way I could have low bone density.
Because of everything I know about menopause and bone health, I decided to ask my doctor for a DEXA scan. The recommended age is 65, but based on current research that is often too late. I expected to get a baseline score, not a diagnosis of osteopenia.
To be fair, I have been in menopause for over 9 years, and I have Hashimoto’s (an autoimmune thyroid condition), both of which increase the risk of low bone density. However, I have also been on menopause hormone therapy (MHT/HRT) since age 51, which has been shown to help maintain or increase bone density. And the earlier you start, the better, especially since bone density loss begins 2 years leading up to menopause (when your period ends) and continues into the early postmenopausal years.
So, there’s my backstory.
After my diagnosis, I went into a deep dive on what to do to reverse or prevent osteopenia, and I want to share with you what I have learned so far.
First, I want to be very clear: I understand that a diagnosis of osteopenia (and osteoporosis) can feel very scary and overwhelming. But you can improve your bone density by doing the right things and it is not too late to start.
So, what can you actually do to improve bone density?
The good news? Bone is living tissue. That means it responds to what you do (or don’t do) every single day. If your goal is to improve (or at least maintain) your bone density, you need to focus on a few key pillars:
1. Lift heavy (for you) and consistently
This is the most important piece and also the one many women are not doing correctly or even at all. If you don’t know where to begin, feel free to download my free Meno-Strength Sampler HERE.
Bone responds to load. That means super light weights and high reps won’t cut it if your goal is to build bone (and muscle). You need progressive strength training using weights that feel challenging. The key word here is CHALLENGING. Effort matters the most. You should be struggling to get your last couple of reps complete.
Focus on:
Compound movements (squats, deadlifts, lunges, presses, rows)
Heavier loads (for you) with good form
2–3 strength sessions per week
Reps 4-30, sets 3-4
Intensity: 1-3 reps shy of muscular failure
If you’ve been avoiding strength training, this is your sign to start. And if you’re not sure how, this is where working with a professional can make all the difference. I’m here to help!
2. Add impact (when and if appropriate)
Bones respond to impact forces like jumping, skipping, and hopping. To improve bone density we have to be doing something that has a ground reaction force (GRF) of at least 3 times our body weight. GRF is the relative amount of weight or force that your skeleton is exposed to with various activities. Unfortunately, walking (1.2 x body weight GRF) and even running (2.5 GRF) is not enough. Whereas jumping and hopping can be 4-6 x your body weight.
Now, this isn’t a one-size-fits-all recommendation. If you have injuries, joint pain, or more advanced bone loss, you need to be smart about how you add this in. But for many women, incorporating some level of impact can be incredibly beneficial. And, if you can’t jump, there are still some options for you.
Start where you are, and progress gradually.
Here are some examples:
Heel drops
Foot stomping
Bounding drills or skipping
Depth Jumps with Rebound or modified depth jump without rebound
Jumping rope or jumping jacks
How much jumping is required?
40-50 jumps a day (which can be broken up throughout the day).
2-3 times a week can improve bone density.
3. Add balance training
This won’t actually help reverse osteopenia, but it’s so important that I can’t leave it off this list. Since 80-90% of osteoporotic fractures happen due to falls, the key is to prevent falling in the first place. So, balance exercises are super important. Adding in some static and dynamic balance exercises are important. Stepping over obstacles, navigating steps, and adding load over time if appropriate.
4. Eat enough protein (and overall calories)
You cannot build or maintain bone if you are not getting enough protein. Protein plays a key role in bone health, muscle mass, and overall strength which support your skeleton.
A general target for most midlife women:
Around 0.8–1.0 grams of protein per pound of body weight
And just as important: make sure you are eating enough overall. Chronic under-eating can absolutely contribute to bone loss.
5. Important key nutrients
Calcium and vitamin D matter, but they are not the whole story.
You want a well-rounded, nutrient-dense diet that includes:
Calcium-rich foods (dairy, leafy greens, fortified foods) - I always recommend a food first approach wherever possible and food based supplements if needed. Seen Calcium Chews are the ones I use and love! Usecode HILARY10 to get 10% off your first order.
Vitamin D (sun exposure and/or supplementation if needed). It’s good to get your numbers checked to see if you need to take a supplement. Most of us do, especially in winter.
Magnesium, vitamin K, and other micronutrients that support bone health
6. Consider hormone therapy
Hormones, especially estrogen, play a major role in bone density. This is why we see accelerated bone loss during the menopause transition.
For some women, menopause hormone therapy (aka HRT) can be a powerful tool in preserving bone density. This is always an individual decision to discuss with your doctor.
But, we cannot talk about bone health in midlife without talking about hormones.
7. Be consistent (This is a long game)
This is not a quick fix. Bone remodeling is a slow process. What you do over the next 6–12 months and beyond matters far more than what you do for a few weeks. Small, consistent actions add up.
Bottom Line
Osteopenia is not a life sentence. It is a wake up call. It’s telling you to start training smarter, fueling better, and paying attention to the things that truly support your long-term health.
And the best time to start? Right now. It’s not too late. Really.
References:
Florence G, et al. Skeletal site-specific effects of jump training on bone mineral density in adults: a systematic review and meta-analysis. Journal of Sports Sciences. 2023 Dec;41(23):2063-2076. doi: 10.1080/02640414.2024.2312052. Epub 2024 Feb 2. https://pubmed.ncbi.nlm.nih.gov/38305252/
Nikander R, Sievänen H, Heinonen A, Daly RM, Uusi-Rasi K, Kannus P. Targeted exercise against osteoporosis: a systematic review and meta-analysis. BMC Med. 2009;7:24.https://pubmed.ncbi.nlm.nih.gov/20663158/ Carrie‐Anne Ng, et al. Effects of Moderate‐ to High‐Impact Exercise Training on Bone
Structure Across the Lifespan: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials. Journal of Bone and Mineral Research, Volume 38, Issue 11, 1 November 2023, Pages 1612–1634, https://doi.org/10.1002/jbmr.4899
Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial. J Bone Miner Res. 2018;33(2):211–220.https://pubmed.ncbi.nlm.nih.gov/28975661/
