For as long as I can remember, my mother—who I look so much like that strangers sometimes treat us like before-and-after photos—has talked about certain things about herself using “we.” She’d lump us together in this small, unlucky group cursed with tiny, annoying problems. We don’t look good in red. We should never wear silver jewelry. But one thing she said more than anything else: We will get osteoporosis. Her mother had it, she’d say, and so did her grandmother. Our bones are small, she’d explain. And you never really drank much milk as a kid.
Not long ago, I had a minor but annoying stomach issue that meant I had to take a low dose of a steroid. One of its rare, theoretical side effects was a possible drop in bone density. To be safe, my doctor ordered a DEXA scan—an imaging test that measures bone mineral density and estimates your future risk of fractures. I don’t remember much about the X-ray itself, but I’ll never forget the worried look on the specialist’s face when he went over the results a few weeks later.
“You’re 37?” he asked, sounding shocked.
Almost all of my vertebrae showed signs of osteopenia, which is the medical term for low bone density and often a step before osteoporosis. Two of them were already in the osteoporosis range.
He asked if I had any children. Yes, I said, one. Then he asked if I planned to have more.
“I’m not sure,” I said. “Probably?”
In that case, he sighed, there wasn’t much we could do. Until I had and weaned my possible second child (and definitely my last, I told him), I couldn’t take any of the available medications. Like most drugs, they haven’t been tested on pregnant women. He told me to keep taking calcium and to add strength training to my workouts. “Try not to fall,” he added.
In the months after that, I started noticing that something I’d always thought of as a concern for older people—something from AARP mailers—was now being treated like a trendy health topic, right up there with green juice. I walked past boutique gyms advertising bone-building classes and clicked on alarming headlines from major news sites. At the gym, people were standing on a vibrating platform that looked like a giant hockey puck, supposedly to strengthen their bones while doing leg lifts. Glossy-haired influencers in perimenopause kept popping up in my feed, talking about bone density and the hormonal changes in midlife that cause it to drop.
Endocrinologist Dr. Caroline Messer says the rise in awareness is partly due to the popularity of GLP-1 drugs. “With any kind of weight loss, you have a higher risk of bone loss, so I think that’s the main reason we’re hearing so much about it now,” she says. “The standard recommendation is to screen women starting at 65, and honestly, I think that’s terrible.” More and more doctors, she adds, are starting to screen patients earlier, like she does, at the first signs of irregular periods.
By the time osteoporosis is diagnosed—usually after a hip or spine fracture—many years of bone loss have already happened. Most people reach their peak bone mass by age 30. The higher that peak is, the more bone you have left later in life to protect you. For most people, building that bone “savings account” doesn’t require anything extreme—just regular, unglamorous habits: enough calcium and vitamin D, enough protein, and a consistent weight-bearing exercise routine. The available drugs generally fall into two types: ones that slow bone loss and ones that help build new bone. These drugs are usually only for people who already have osteoporosis.
“My patients are all very good about their breast health,” said Dr. Steven R. Goldstein. “I wish everyone were as careful about their bones.”But we may be on the brink of a new era in preventative treatment. Promising new research looks at a “biological switch”—normally triggered by exercise—that helps keep bones strong, offering a potential path for drugs that could mimic physical activity. New screening technologies, based on bone flexibility rather than mineral density, may catch issues earlier than before. And in 2024, the FDA cleared Osteoboost, a new wearable device for osteopenia. Fitted like a belt, it delivers vibration to the hips and lower spine. Bone constantly renews itself, driven by specialized cells that break down old bone while others build new mineral in its place. Those cells are highly responsive to mechanical stress—which is why weight-bearing exercise strengthens the skeleton—and the device is designed to mimic 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 believes low-bone-density awareness has suffered from what she calls “double discrimination.” It’s a condition that disproportionately affects women, yes—but she also thinks women themselves tend to downplay it. “It’s common for older women to get osteoporosis,” she says. “In fact, almost all women will. But it used to be inevitable that people would get high blood pressure, too.”
“Fear is a wonderful motivator,” says Dr. Steven R. Goldstein, 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 says. “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 never live independently again. Goldstein admitted these numbers usually 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 Good Day Pilates studio opened half a block from my Brooklyn apartment. Founded by physical therapist Clara Gilmour, the studio offers classes that use heavy resistance bands and the occasional kettlebell to provide what Gilmour calls, appealingly, a “strengthening dose.” For someone like me, she says, a classical ballet-style Pilates class with lots of stretching might not be enough. “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 being incredibly close, I like that the studio has no mirrors, and I can convince myself that taking a class is a non-negotiable kind of medicine.
Is it working? I might not know for decades, but wanting a second opinion—or maybe just reassurance that I wasn’t already halfway to crumbling into dust—I call Dr. David Karpf, 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 tool, especially for people whose bones, like mine, are smaller than average.
“Let’s calculate your fracture risk right now,” he suggests, firing off a list of rapid 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 numbers 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 scanKarpf explained that what she had likely captured was simply the natural result 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 after I hung up the phone, I have to admit I was tempted to cancel my upcoming Pilates class. But that wasn’t the point. Even if the story my mother told wasn’t quite as inevitable as it sounded, I felt I should do everything I could to counteract this family curse. So I keep dragging myself to Pilates and taking a calcium supplement with my coffee. And soon, I’ll probably buy an Osteoboost belt, which will vibrate at the base of my spine as I walk to pick up my daughter from daycare—where I’ve started bringing her a sippy cup of milk.
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