Bone density, an often-overlooked component of girls’s well being, performs a important function in our total well-being and high quality of life as we age. In contrast to cardiovascular health or muscle tone, which are likely to obtain extra consideration in discussions of girls’s well being, bone energy quietly underpins every little thing from our capacity to maneuver freely to our resistance in opposition to fractures and long-term incapacity. The gradual and infrequently silent decline of bone density, significantly in ladies, makes early schooling and screening, reminiscent of bone density (DEXA) scans as early as age 50, a significant a part of preventative well being care.
Bone mineral density (BMD), refers back to the quantity of bone mineral (hydroxyapatite) in bone tissue. It’s measured utilizing a DEXA scan (Twin-Vitality X-ray Absorptiometry), which evaluates the energy of bones and the chance of fractures. These scans yield two kinds of outcomes: the T-score and the Z-score.
T-score compares your bone density to that of a wholesome 30-year-old grownup.
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A T-score of -1.0 or above is regular.
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A rating between -1.0 and -2.5 signifies osteopenia, a situation the place bone density is beneath regular and should result in osteoporosis.
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A rating of -2.5 or decrease alerts osteoporosis, a illness characterised by fragile bones and an elevated threat of fractures.
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Z-score compares your bone density to the common of somebody your age, intercourse, and weight.
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A Z-score considerably beneath common (lower than -2.0) might point out that one thing apart from growing older is inflicting irregular bone loss and will immediate additional investigation.
For ladies, bone density is at its peak between the ages of 20 and 29. Throughout this decade, the bones are the strongest and densest they may ever be. Nevertheless, this window is fleeting.
Starting round age
30, bone mass naturally begins to say no. The loss is gradual and
regular at first, usually going unnoticed. By the point we’re in our
40s, the speed of bone loss begins to speed up, particularly within the
years main as much as menopause. Girls might start to point out indicators of
osteopenia even with out signs. Round 50, we start to enter
menopause and our estrogen ranges drop dramatically. As a result of estrogen
is a key hormone in sustaining bone mass, this hormonal shift leads
to a speedy lower in bone density, rising the danger for
osteoporosis. In our 60s and past, with out intervention, the danger
of osteoporosis rises sharply. By this time, many ladies might
expertise fractures or be taught of low bone mass solely after an harm.
The
Position of Menopause and Hormonal Adjustments
Estrogen performs a
central function in bone transforming, a course of by which bones frequently
rebuild themselves. Throughout menopause, the sharp decline in estrogen
disrupts this stability, tipping the size towards bone resorption
(breakdown) fairly than bone formation. That is why ladies are at a
far higher threat of osteoporosis in comparison with males, particularly after
menopause.
Circumstances like early
menopause, surgical elimination of ovaries, or amenorrhea (lack of
menstruation resulting from underweight or excessive bodily stress) can carry on
early bone loss. Moreover, medicines reminiscent of corticosteroids,
sure thyroid remedies, and even some most cancers therapies can scale back
bone density over time.
Why
Get a Bone Scan by Age 50?
Many well being
organizations advocate ladies start routine DEXA scans at age 65 or
earlier if threat components are current. Nevertheless, by this age,
substantial bone loss might have already occurred. Detecting adjustments in
bone density by age 50 permits ladies to take early motion, together with:
Implementing Power
Coaching: Resistance and weight-bearing workout routines stimulate bone
formation. Girls who carry weights, particularly heavy weights reminiscent of
the compound barbell actions (squats, deadlifts, presses), are likely to
keep and even enhance their bone density.
Supplementing Properly:
Ample consumption of calcium and vitamin D is crucial. Vitamin D
helps the physique take up calcium and keep wholesome ranges within the
bloodstream. Girls with vitamin D deficiency (beneath 30 ng/mL) are at
higher threat of bone loss and fractures.
Addressing Life-style
Dangers: Smoking, extreme alcohol consumption, and really low
body weight all improve the danger of osteopenia and osteoporosis.
Figuring out these components early can enable for life-style interventions
that protect bone mass.
Monitoring Remedy
Affect: Some medicines have an effect on bone density. Early scans may also help
monitor bone loss in ladies present process therapy for different situations.
By age 50, most girls
are coming into perimenopause or are already in menopause. This era
is important for assessing well being dangers, and including a bone scan to
routine checkups can uncover points earlier than a fracture happens. It
needs to be considered as important as mammograms or colonoscopies.
Actual-World
Proof: Case Research in Power
Beneath are real-world
case research of 4 ladies between the ages of fifty and 70 and the
evaluation of their bone scans through the time they applied
energy coaching into their life-style.
Case Examine No. 1:
M.S., a 75-year-old postmenopausal feminine.
M.S. has been coaching
at Fivex3 since December of 2019. As a consequence of COVID, there was a 2.5 month
interval from the center of March to the tip of Might in 2020 when she
was unable to coach because of the health club closure. M.S. resumed coaching in
June of 2020. She is a 75-year-old postmenopausal lady who underwent
a BMD scan in 2023 that exposed ongoing issues relating to her
skeletal well being. The scan indicated a prognosis of osteoporosis in
the femoral neck and osteopenia within the lumbar backbone, together with
moderate-to-high fracture threat over the subsequent decade. Her earlier
scan was in 2021, and he or she is at present taking Boniva, a prescription
treatment used to deal with and forestall osteoporosis in postmenopausal
ladies.
The World Well being
Group defines osteoporosis as a BMD T-score of -2.5 or decrease.
M.S.’s scan outcomes verify this prognosis in each hips:
- Left Femoral Neck:
T-score of -2.5 - Proper Femoral Neck:
T-score of -2.8
These scores place her
firmly inside the osteoporotic vary and are clinically vital
as a result of the femoral neck is a standard web site for debilitating hip
fractures in older adults. Whereas her lumbar backbone presents a T-score
of -1.7, that is categorized as osteopenia, a precursor to
osteoporosis that additionally carries a notable threat for fracture,
significantly within the setting of growing older and hormonal adjustments.
The accompanying
Z-scores (Left Hip: -0.91; Proper Hip: -0.85; Backbone: 0.08) provide a
comparability to age-matched friends. These values counsel that whereas her
bone density is barely beneath common within the hips, her lumbar backbone
BMD is actually common for somebody her age.
One of many extra
encouraging elements of the 2023 report is the constructive pattern in bone
density in comparison with her 2021 scan (throughout which she was coaching
persistently 3x week):
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Left Hip: +2.9%
improve in BMD -
Proper Hip: +6.9%
improve -
Lumbar Backbone:
+6.2% improve
These positive aspects counsel
delicate however significant enhancements, probably resulting from life-style adjustments,
residual results of earlier medicines, or elevated
calcium/vitamin D consumption. Nevertheless, these enhancements, whereas
statistically notable, don’t reverse the underlying prognosis. M.S.
nonetheless qualifies as osteoporotic in each hips and stays at excessive
fracture threat. However whereas she might qualify as osteoporotic in her hips,
I want to see a more moderen scan in 2025. If there was a rise in
each hips and her lumbar backbone between 2021 and 2023, I think about there
could be one other improve in BMD between 2023 and 2025/2026.
Case Examine No.2:
H.P., a 59-year-old postmenopausal feminine.
H.P. is a 59-year-old
feminine present process therapy for bone well being and has had a number of BMD
scans over time, offering a priceless longitudinal dataset for
understanding her skeletal well being trajectory. She has been taking
prednisone – a corticosteroid – for about 15 years.
Corticosteroids are well-known for his or her catabolic results,
significantly in decreasing bone mineral density. H.P. was identified
with osteoporosis three years in the past.
Her information spans from
2010 (age 43) to 2024 (age 58), and contains measurements taken
earlier than and after notable scientific interventions or treatment utilization.
In 2010 H.P. began taking treatment for bone density. H.P. joined
a health club in 2007 and has been very lively through the years between 2007
and 2023. Previous to October 2023, her health routine included
spinning, physique pump, and boot camp-style exercises 4–5 instances per
week.
Her first scan was in
2010 and presently, H.P.’s BMD on the AP backbone was 0.925 g/cm³,
comparable to a T-score of -1.1, which falls into the “osteopenia”
vary. By 2012, there was a modest improve to 0.940 g/cm³
(T-score: -1.0), an enchancment of 1.7%. This delicate acquire, although
small, indicated relative skeletal stability throughout this early
interval. In 2010, H.P.’s left hip BMD was 0.920 g/cm³
(T-score: -0.2), thought of inside the regular vary. By 2012, the
worth elevated barely to 0.947 g/cm³
(T-score: 0.0), a 2.9% acquire, indicating wholesome bone transforming and
density.
Nevertheless, there was an
11-year interval between her scan in October of 2012 and her scan in
June of 2023 which noticed a steep and regarding decline in backbone BMD to
0.750 g/cm³,
a lack of roughly 18.9% from baseline and over 20% in comparison with
the 2012 degree. The corresponding T-score dropped to -2.7, bordering
on the edge of osteoporosis (outlined as T-score -2.5). In
addition to her decline within the backbone, from 2012 to 2023, her BMD at
the hip declined by roughly 13.9%, reaching 0.792 g/cm³
(T-score: -1.2), signaling a transfer into osteopenia territory. Though
the decline was much less dramatic than on the backbone, it nonetheless represented
a major long-term discount in bone energy and density.
What modified throughout
this time to trigger such a dramatic decline? Throughout this time interval,
H.P. had stopped taking her bone density treatment resulting from GI
issues and had additionally began hormone alternative remedy as she
was going via menopause. The decline in her BMD was nearly
definitely resulting from her stopping her bone density treatment and the
onset of menopause in addition to her lack of weight-bearing train.
Regardless of H.P.’s lively life-style, it’s most definitely attainable that
the character of her train – whereas cardiovascularly helpful –
didn’t sufficiently stimulate bone transforming in a manner that focused
the areas most in danger for osteoporotic fractures (e.g., backbone,
hips). This underscores a key distinction between normal health and
focused resistance coaching when it comes to bone well being.
In October of 2023,
H.P. give up the health club she had been going to since 2007 and joined Fivex3 Training. She started a devoted energy coaching program which
concerned the compound lifts – squats, bench press, deadlift, and
overhead press. This meant no extra boot camp lessons, spinning, or
physique pump lessons. One yr later, in October of 2024, she had her
fourth DEXA scan and a notable and inspiring shift occurred between
from June 2023 (4 months earlier than becoming a member of Fivex3) and October 2024,
along with her BMD rising within the AP Backbone from 0.750 to 0.805 g/cm³
— a 7.2% acquire. The T-score improved to -2.2, pulling it again into
the osteopenic vary.
Most importantly,
this acquire exceeds the Least Vital Change (LSC) threshold of
0.022 g/cm³,
which implies the advance is statistically vital and certain
displays a real organic response fairly than measurement
variability. This constructive pattern strongly signifies that H.P.’s
therapy – probably pharmacologic (e.g., bisphosphonates, anabolic
brokers) or lifestyle-based (e.g., her new energy coaching program)
– has been efficient. In different phrases, the energy coaching program
was working!
Her BMD on the hip
remained comparatively secure at 0.789 g/cm³
– a slight lower of simply 0.4%, which is properly beneath the LSC of
0.027 g/cm³.
This minimal change suggests a plateau in bone loss on the hip,
probably reflecting the stabilizing results of therapy, though
not but robust sufficient to induce a reversal as noticed within the backbone.
In conclusion, the AP
backbone, which was essentially the most important space of concern because of the
dramatic loss between 2012 and 2023 was adopted by a statistically
vital and clinically significant enchancment within the final yr.
This reversal implies efficient current intervention (like starting a
energy coaching program). Within the hip, the decline was much less extreme
in comparison with the backbone, and whereas no vital enchancment has
occurred but, the current stabilization is a constructive signal that the
therapy could also be starting to halt additional degradation.
As H.P. notes after we
mentioned her most up-to-date scan, “I’m bodily stronger and have
higher endurance. I additionally really feel like I’m psychologically stronger as
I’m taking cost of my well being and am combating growing older and a well being
situation that requires power steroid use. Getting one more
prognosis (osteoporosis) actually weighed on me and after a brief
interval of being upset, I got down to put within the work required to at
least keep the bone density that I’ve. To date it is working!!”
Case Examine No. 3:
E.R., a 70-year-old postmenopausal feminine.
E.R.’s bone well being
trajectory over a six-year interval from 2018 to 2024 gives an
informative and nuanced image of skeletal growing older and resilience. The
evaluation focuses on two clinically vital areas: the
anteroposterior (AP) backbone (L1–L4) and the left whole hip. Notably,
E.R. has not used osteoporosis medicines throughout this timeframe,
permitting an unfiltered view of pure or lifestyle-mediated adjustments
in bone mineral density. The info reveal divergent developments between the
backbone and hip, warranting a focused interpretation of her outcomes.
E.R. began taking
CrossFit lessons in 2018/2019 however then stopped attending these
lessons in 2020 resulting from Covid. Throughout this time, she additionally underwent
meniscus surgical procedure on her left knee resulting from an harm and was doing PT
till October of 2020.
In November of 2020,
she started energy coaching at Fivex3 Training and has been coaching
there 3 days every week for the previous 4.5 years. We began very slowly,
being very conservative with the knee. In July of 2023, she had a
second meniscus surgical procedure on the precise knee. Earlier than her surgical procedure, she
was nonetheless coaching however having an increasing number of problem with the knee.
She adopted up her surgical procedure with bodily remedy for 3 months,
from July to September, and returned to Fivex3 Coaching in October
2023.
The AP backbone has
demonstrated a positive trajectory in BMD, progressing from a
baseline of 0.739 g/cm³
in 2018 to 0.797 g/cm³
in 2024. This 7.8% improve surpasses the area’s Least
Vital Change (LSC) threshold of 0.022 g/cm³,
confirming the acquire is statistically vital and never merely a
reflection of measurement variability. Extra importantly, the
related T-score improved from -2.8 to -2.3, remaining inside the
osteopenic vary however transferring towards regular bone density.
This constructive shift in
spinal BMD is clinically significant. It reverses a previous interval of
decline, with the bottom recorded backbone BMD occurring in 2022. The
rebound since then not solely displays bone restoration but additionally suggests
potential stabilization. Since no pharmacologic remedies had been used,
this enchancment probably stems from life-style interventions, reminiscent of
weight-bearing train (i.e. squats, bench, overhead press and
deadlift) and dietary consumption (calcium and vitamin D).
The left whole hip
tells a extra regarding story. From a baseline BMD of 0.786 g/cm³
in 2018, there was a internet lack of 8.7%, culminating in a BMD of 0.718
g/cm³
in 2024. This discount was accompanied by a T-score decline from
-1.3 to -1.8 – remaining inside the osteopenic vary however
approaching the edge for osteoporosis. Whereas the decline is
clinically vital, current information present a glimmer of cautious
optimism: between 2022 and 2024, there was a modest BMD improve of
0.019 g/cm³
(+2.7%).
The bone loss within the
left hip will not be too stunning because it was the left knee that she had
injured in 2019 and had meniscus surgical procedure previous to starting her
energy program at Fivex3 Coaching. Regardless of this, the slowed fee of
decline suggests a possible stabilization in hip BMD. As with the
backbone, the absence of pharmacological intervention factors to
non-medication-related advantages, though the hip seems to be extra
proof against restoration. This might mirror variations in mechanical
loading or regional sensitivity to systemic adjustments. (i.e. her knee
surgical procedure.)
E.R.’s six-year bone
well being expertise displays each vulnerability and resilience. Her
backbone has demonstrated a significant and statistically vital
enchancment in BMD, providing proof of constructive change and
efficient skeletal upkeep with out treatment. Conversely, her
hip has undergone a reasonable decline, with solely current indicators of
attainable stabilization.
Case Examine No. 4:
L.H., a 60-year-old postmenopausal lady.
Between 2021 and 2025,
L.H. underwent three DEXA scans that tracked her development and
partial restoration of bone mineral density (BMD) throughout a medically
complicated interval. Her skeletal well being shifted from osteopenia to
osteoporosis after which again towards osteopenia, reflecting the mixed
affect of trauma, systemic sickness, pharmacologic remedy, and
life-style modifications, together with structured resistance coaching.
L.H. had her first DEXA scan in February of 2021, prompted by household
historical past issues. Her preliminary DEXA scan revealed osteopenia at
a number of skeletal websites.
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Lumbar
Backbone: BMD 0.874 | T-score: -1.6; Z-score: -0.4 Osteopenia -
Left
Hip (Complete): BMD 0.852 | T-score: -0.7; Z-score: 0.0 Regular -
Left
Femoral Neck: BMD 0.671 | T-score: -1.6; Z-score: -0.5 Osteopenia -
A
1-inch peak loss (from 5’6″ to five’5″) was documented,
probably resulting from early spinal compression or postural shifts. At this
stage, bone loss was delicate and didn’t meet standards for
osteoporosis. -
Two
years later, she had a comply with up scan in March of 2023 and
sadly, it was not what she anticipated because it marked vital
deterioration. -
Lumbar
Backbone: BMD 0.762 | T-score: -2.6; Z-score: -1.3 Osteoporosis -
Left
Hip (Complete): BMD 0.791 | T-score: -1.2; Z-score: -0.4 Osteopenia -
Left
Femoral Neck: BMD 0.610 | T-score: -2.2; Z-score: -0.9 Osteoporosis
Nevertheless, previous to this
2023 scan, in November 2022, L.H. suffered three pelvic fractures in
a high-speed bicycle accident. This traumatic occasion most certainly led
to decreased mobility and elevated systemic stress, each threat
components for speedy bone loss.
So as to add extra gas to the
hearth, one yr later, in February of 2024, L.H. had a CT scan
adopted by a PET scan in March, in addition to a Bronchoscopy (a medical
process the place a health care provider makes use of a skinny, versatile tube referred to as a
bronchoscope to look at the airways and lungs). After this process,
she was identified with lung most cancers and had a lobectomy of the higher
left lung and a wedgectomy (wedge resection) of the decrease left lung.
She started chemotherapy in June of 2024 and accomplished her final
therapy in August. L.H. started immunotherapy in September of 2024.
One yr later, in June
of 2025, she had her third bone scan. This scan was way more
promising than her 2023 scan. Regardless of a lung most cancers prognosis and
intensive therapy, L.H’s 2025 DEXA scan confirmed modest BMD
enchancment throughout all measured websites. Notably, the lumbar backbone
T-score improved sufficient to maneuver out of the osteoporotic vary,
indicating profitable skeletal stabilization. That is particularly
outstanding given the bone-depleting results of chemotherapy and
systemic sickness.
- Lumbar Backbone: BMD 0.805
| T-score: -2.2; Z-score: -07 Osteopenia (improved from osteoporosis)
– A rise of 5.7% - Left Hip (Complete): BMD
0.824 | T-score: -1.0; Z-score 0.0 Osteopenia (getting near being
regular once more) – A rise of 4.1% - Left Femoral Neck: BMD
0.625 | T-score: -2.0; Z-score 0.7 Osteopenia – A rise of two.5%
What might have made
the distinction between her 2023 scan of osteoporosis and her 2025
scan that put her again within the osteopenia vary?
1. She started a as soon as a
yr infusion of Reclast, a potent once-yearly bisphosphonate that
reduces bone turnover and fracture threat.
2. She started a
constant, once-a-week energy coaching program in June of 2024 at
Fivex3 Coaching.
On Might 28, 2024, L.H.
emailed Fivex3 Coaching. “Hi there. I’m 59 and have been an athlete
most of my life. Just lately identified with each osteoporosis and
most cancers. I’m on the lookout for a energy program to maximise my muscle mass
and do my greatest to bulk up.”
On June 10, 2024, one
week after her first chemotherapy therapy, L.H. started a structured
weekly barbell energy coaching program, incorporating squats, bench
presses, overhead presses, and deadlifts. She continued this routine
all through chemotherapy (June – August) and immunotherapy (September
– July) and stays in keeping with it right this moment.
This kind of
high-intensity, compound motion coaching is likely one of the most
efficient non-pharmacologic methods for exciting osteogenesis,
significantly in postmenopausal ladies. Its timing – coinciding with
BMD enchancment regardless of systemic stress – strongly suggests a
constructive synergistic impact alongside Reclast in selling skeletal
resilience.
L.H.’s case is a
compelling instance of how multi-modal intervention – pharmacologic,
rehabilitative, and behavioral – can enhance bone well being even in
the context of trauma and systemic illness. Her BMD positive aspects, whereas
modest, are clinically significant and inspiring. With continued
engagement in therapy and life-style administration, L.H.’s skeletal
well being can stay secure – and even enhance – regardless of age-related
and oncologic challenges.
Case Examine No. 5:
E.S., a 50-year-old menopausal feminine.
E.S. is a 50-year-old
lady whose bone well being displays the long-term advantages of an lively
life-style and energy coaching. Her first and up to date DEXA scan
reveals a skeletal profile that’s not solely well-preserved but additionally
unusually strong for her age. This case offers a singular alternative
to discover the intersection of life-style, physiology, and diagnostic
interpretation within the context of bone well being.
E.S. has maintained a
bodily lively life-style for almost her total life. From early
childhood till age 35, she participated in dance, first at a
aggressive degree and later recreationally. At age 35, she
transitioned into energy coaching, partaking in constant,
progressive resistance train for the previous 15 years. Her routine
contains elementary compound actions reminiscent of squats, deadlifts,
bench presses, and overhead presses – workout routines identified to exert excessive
mechanical hundreds on the skeleton, particularly on weight-bearing bones
such because the backbone and hips. This longstanding dedication to
bodily demanding exercise is a key contextual issue for
deciphering her DEXA outcomes.
E.S.’s DEXA scan of
the lumbar backbone (L1–L4) confirmed particular person BMD values starting from
1.341 to 1.440 g/cm³,
with a median of 1.366 g/cm³.
These values translate to T-scores between +3.0 and +3.6, and
Z-scores between +3.6 and +4.3. In keeping with the World Well being
Group (WHO), a standard T-score lies between -1.0 and +1.0. Her
scores far exceed this vary, indicating a bone density greater than
three commonplace deviations above the younger grownup imply – an
terribly uncommon consequence.
Whereas excessive BMD is
sometimes advantageous and suggests superior skeletal energy, the
magnitude of E.S.’s scores is uncommon. Z-scores higher than +2.0
are additionally thought of elevated when in comparison with age-matched norms,
which can immediate additional analysis. Though these outcomes elevate
questions on potential underlying components, they should be
interpreted within the broader context of her well being and life-style.
In distinction to the
exceptionally excessive spinal scores, E.S.’s femoral neck and whole hip
BMD outcomes fall inside the high-normal vary. Her femoral neck BMD
measured 1.029 g/cm³
with a T-score of +1.6, whereas her whole hip BMD was 1.158 g/cm³
with a T-score of +1.8. Z-scores for these areas had been +2.4 and
+2.2, respectively. These values verify that E.S.’s skeletal
robustness will not be remoted to the backbone and mirror constant
adaptation throughout a number of anatomical websites resulting from mechanical loading
and muscular improvement.
To enrich BMD, her
lumbar backbone DEXA picture was additionally analyzed utilizing Trabecular Bone Rating
(TBS), which evaluates bone microarchitecture. Her TBS was 1.552,
properly above the edge of 1.31 that signifies wholesome trabecular
construction. This discovering affirms the standard and group of her
bone tissue, supporting the interpretation that her excessive BMD displays
not simply density but additionally structural integrity.
E.S.’s complete
scan outcomes counsel a particularly low threat of osteoporotic fracture.
Her elevated BMD, favorable TBS, and absence of any historical past of
fragility fractures all contribute to a skeletal profile that’s
resilient and structurally sound. The FRAX software, used to estimate
10-year fracture likelihood, was deemed pointless resulting from her excessive
T-scores, additional underscoring her low threat.
E.S.’s case
exemplifies how a lifetime of bodily exercise – significantly
involving weight-bearing and resistance coaching – can yield
extraordinary advantages for skeletal well being. Her outcomes not solely
spotlight the potential of life-style interventions in preserving bone
energy but additionally function a reminder to method outlier values with
cautious, contextual interpretation. E.S. represents an optimum case
of midlife bone well being. Her DEXA scan outcomes mirror each a
high-density and high-quality skeletal construction, positioning her at
minimal threat for fracture and offering a strong mannequin for wholesome
growing older.
Conclusion:
Robust Bones, Stronger Girls
Girls not have to
settle for declining bone density as only a “a part of growing older” or endure
silently via the results. We’re in an period the place data
is accessible, preventative care is inspired, and private company
is well known.
Speaking about
menopause, osteopenia, and osteoporosis overtly – as Gen X ladies are
doing now – permits us to rewrite the narrative for ourselves and
future generations. A DEXA scan at age 50 isn’t just a diagnostic
take a look at. It’s a declaration that you simply matter, that your well being is value
monitoring, and that you’re not powerless within the face of growing older.
Robust bones are usually not
in-built a day, however the resolution to begin defending them could be made
right this moment.
