I Had My DEXA Scan Today — Let’s Talk About Bone Loss in Perimenopause

You can be doing everything “right” in midlife and still be losing bone without a single symptom. After heading in for my two year follow up DEXA scan, I talk straight up about the thing most women never think to check - bone mineral density, osteopenia, and what it means for your future mobility. 

We unpack what a DEXA scan actually measures (hip and spine), how the T-score works, and why the raw numbers and your personal risk factors matter more than a single label. I also share why I had to advocate for herself with my GP, why many women in Australia won’t be offered testing until much later, and how getting data early creates options rather than fear. 

From there, we connect the dots between perimenopause, menopause, and accelerated bone loss as oestrogen declines. You’ll get practical, clinician-informed guidance on nutrition and supplementation (calcium from food, vitamin D testing, and why vitamin K matters), plus the real cornerstone of bone health: safe, progressive resistance training, impact, and building muscle to reduce falls and protect independence. We also touch on protein, weight loss approaches that can backfire, and where menopause hormone therapy (MHT) fits into the bone conversation. 

If you want a body that lets you travel, lift, climb stairs, and live confidently for decades, press play now. Subscribe or follow, share this with a woman you care about, and leave a review if it helps. What’s one bone health habit you’re ready to start this week?

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Transcript

Welcome And Why Bone Health

SPEAKER_00 0:00

Hi, I'm Susie Garden and this is the Ageless and Autumn Podcast. I'm an age-defying naturopath and clinical nutritionist and I'm here to bust myths around women's health and ageing so that you can be ageless and awesome in your 40s, 50s, and beyond. The Ageless and Awesome Podcast is dedicated to helping women through perimenopause and menopause with great health, a positive mindset, and outrageous confidence. Hit subscribe or follow now and let's get started. Hello, gorgeous one, and welcome to this week's episode of the Ageless and Awesome Podcast. I'm Susie Garden, naturopath, nutritionist, and founder of the Perimenopause Path. And on today's episode of the podcast, it's actually not the episode that I had planned. I had planned out a whole little series after uh purchasing the gorgeous boutique skin clinic e-skin on the Gold Coast. I was gonna talk a little bit more about skin health. And I got into the episode, wrote out my plan, and then I was like, you know what? I actually don't feel like doing this today. Because something happened today, and uh it just made me completely change my mind about what I wanted to talk to you about. So

The DEXA Scan That Changed Today

SPEAKER_00 1:23

today I had a planned DEXA bone density scan. More specifically, I had my two-year follow-up bone mineral density scan. As I'm recording this, I don't have my results yet. I should have them by the end of the week. Um and so, yeah, but I've really been looking forward to this scan because two years ago, after insisting, insisting that I get one, this is me advocating for myself for no reason other than I just wanted to have a look at my bones. You know, I'm in my 50s. Why can't I have a look at the health of my bones? This is important. And that bone density scan showed I had osteopenia. And so I went on a bit of a journey of trying to improve my bone density, and I'm gonna talk about that in this episode. Um, but at this at the moment, I don't know whether my bone density has improved. I hope it has. Maybe it stayed the same. I'd be happy if it stayed the same. I'd actually be happier than if it got worse. Um, hopefully, I haven't lost more bone over the past two years. And of course, I'm very, very curious, but I just have to be patient and wait. And while I was having the scan today, I started thinking about how little we talk about bone health, really, for women in their 40s and 50s. You hear about it in older women, but not so much women in their 40s and 50s. We talk about weight, we talk about hot flushes, we talk about sleep or lack thereof, we talk about anxiety, brain fog, our skin. But very few women wake up in the morning and go, hmm, I wonder how my bones are doing. Um, because you can't see them, you can't actually feel your bone density declining, by the way. Uh, the reason I wanted to go and get a bone density scan initially was just because I knew the research and I knew that when you're you go through perimenopause and you get into menopause, I knew that you lose your bone density. I think it's around 10% in the first five years, um, after menopause. And I thought, well, I want to get a baseline. It's not that expensive to get the test done. So let's just have a look. Because as soon as you know there's a problem, you can start working to fix it. This bone issue is not something that once you have it, that's it, you're done. You can actually fix it. So um, this is the thing, you can't tell that this is happening, you can't look in the mirror and go, oh, I feel like my bones aren't as dense. And this is a real problem because this bone loss is largely silent, and you can feel completely healthy and be completely healthy while it's happening. Uh, for many women, the the first sign that their bones aren't as strong as they thought is a fracture from an incident that doesn't, you wouldn't really think you'd get a fracture from. And that's often when women first get diagnosed, to be honest. I'd say the majority of women get diagnosed when they actually have a fracture from an incident where they shouldn't have got that fracture normally. And you know, at that point, we've missed years where we potentially could have been doing something about it. So I want to talk about osteopenia today, what it is, why it's so important uh in the context of any menopause or perimenopause conversation, and what a DEXA scan actually is, what it's like, what it tells us. And and most importantly, probably let's talk about what women in their 40s and 50s, yes, you in your 40s, you may think you're too young for this, but I lost a lot of my bone in my 40s. Um, so what women in their 40s and 50s can do now to protect your bones, because you're gonna need them in your 60s, your 70s, your 80s, and hopefully well beyond that. You want to have a great quality of life. So it's not really an episode about osteopenia. It's an episode about future-proofing your body and making sure you have an awesome quality of life from a mobility point of view as you go through the decades. So,

Osteopenia Versus Osteoporosis Explained

SPEAKER_00 5:27

but let's start about what is osteopenia? What is osteoporosis? Yes, they are two different things. So the basics are osteopenia is a form of low bone density, and it means that your bone mineral density is lower than what would be considered normal, but it hasn't reached the threshold used to diagnose osteoporosis, and that's this really important distinction. Osteopenia and osteoporosis are not the same thing. If you think about bone density as like this continuum, at one end you've got this healthy bone density, then you have reduced bone density, which is osteopenia, and then further along that continuum, if you don't do anything to kind of strengthen your bones, then osteoporosis can happen. And osteoporosis means, I mean, if you look at that's Latin porosis, porous, osteobone, porous bones, and it means the bones have become sufficiently weakened that fracture risk is significantly increased. And this is a problem because often in elderly people, when they get a significant fracture like a hip, for example, that the mortality associated with that is quite high. And often that is the start of the beginning of the end kind of thing. So it's so important to keep your bones strong because it keeps you out of hospital, it keeps you mobile, it keeps you safe.

What A DEXA Scan Measures

SPEAKER_00 7:02

So let's talk about the DEXA scan. This is where the DEXA scan comes in. It's it stands for dual energy x-ray absorbtometry. You don't need to remember that. It's a quick, non-invasive scan. It's used to measure bone mineral density, particularly at the hip and the spine. And so it's kind of like having an X-ray taken, you know. You don't have to do any special prep, you don't have to drink any sort of contrast, you don't have to be in a claustrophobic machine at all. It's actually very, very easy. I was you wear clothes. Uh, if you saw my Instagram, you saw I put a gown on. Um, that's just because of some of the clothing I was wearing had metal in it, so um, like jeans. So I yeah, wore a gown and it's literally like getting an x-ray. And they x-ray one hip. Generally, it'll be the left hip. I suspect it's because that's the way the machine is set up, I'm not sure, but they will always do the left hip and the spine. And uh for me, I have osteopenia in my spine, which I'm kind of unhappy about because that means that I'm at high risk of having a spinal fracture, and that is pretty scary, actually. Um, I think I'd probably rather have it in my hip, but you know, you don't get to choose these things. So let's talk about the report. So the one of the numbers you receive when you report generally is called a T-score, and a T-score compares your bone density with that of a young, healthy adult. So a T-score above minus one is generally considered normal. Between minus one and minus 2.5 is considered as osteopenia or low bone density, minus 2.5 or below falls into the osteoporosis range. And that gets into the kind of the serious conversations. So my number on my scan two years ago, my T-score was negative 1.8. And you might think, oh, well, that's not too bad. It's not anywhere near negative 2.5. However, because I'm curious, I went into the act, I didn't just read the report that did say that. I went in and looked at the scan itself where I could see all of the data points. And that is in my lumbar spine. So that is um L1 to L4, is what they look at. We have um that's the L stands for lumbar, and uh one to four of those vertebrae, those first four vertebrae in your lumbar spine. So um that's one that negative 1.8 T score is actually an average. And when I looked at the raw numbers, one of my vertebrae is at negative 2.4. So that's almost osteoporosis in my L4. So obviously that's not ideal, but it's not yet osteoporosis, so that's where I have massive opportunities. But here's something really important the numbers are not the whole story. Your doctor will also consider things like your age, your fracture history, your family history, medications, health conditions, and other risk factors. However, having said that, when I went to my GP initially and said I want a DEXA scan because I didn't have a family history of osteoporosis, I hadn't had any fractures, I'm considered pretty young for osteoporosis, haven't been on any medications, don't really have medical conditions. So I was not someone that looked like a candidate, and I was refused a bone density scan. So I found another GP, a menopause-trained GP, went and sat with her, and she actually proactively said to me, Have you had a bone density scan? And I said, No, and I want one. So she said, of course, go and get one. And that's when I found out I had osteopenia. So I really had to advocate for myself. And I'm lucky because I am educated in health, but this is certainly not something I've really put a lot of thought into. Osteopenia and osteoporosis were probably the last things I was thinking of, even as, you know, a practitioner in this space of uh perimenopause and menopause. It's just not been something that was particularly emphasized. Uh, and our healthcare system reflects that you can't get a Medicare in Australia, a Medicare rebate, if you're under 70 years old. So you do have to pay for it. And this is the thing, I had to pay for it. And even then, my GP, my first GP, refused, even though I was paying for it myself. So you do have to advocate for yourself. I mean, it cost me today $145, which to me is nothing compared to the opportunity that it's now given me to reverse it because it is reversible. And this is what's so awesome about having this knowledge and about getting when you have information, you can actually do something about it. So I'd strongly recommend if you're in your 40s or 50s, you haven't um ever had a DEXA bone density scan, you probably will not be offered it unless you happen to say the doctor that your mother or grandmother had osteoporosis at a young age. Um, so asking for one for yourself, if you get the great news that you don't have anything to worry about, that's awesome. And if you're like me and you get the news that we've got a problem, then this is the opportunity you have now to actually reverse it. And it is important you do work with a medical professional on this, you don't just get your report, Google it, put it into chat and diagnose yourself, and then, you know, that that's not the best uh kind of way to go about it. The scan gives the information, but it doesn't replace clinical assessment. So

Menopause Hormones And Silent Bone Loss

SPEAKER_00 13:05

let's talk about how and why menopause and perimenopause changes the conversation about this. And this is why I'm discussing it on a, you know, this podcast is because of the loss of hormones, is one of the things that accelerates the bone loss, and particularly estrogen, although testosterone and progesterone have roles. We normally obviously associate estrogen with reproduction and with symptoms such as our hot flushes and periods and ovulation and all the things. But um, estrogen plays an incredibly important role in maintaining our skeleton, and our bones aren't just these static kind of pieces of scaffolding that were built when we were young and then just sit there for the rest of our lives. Bone is living tissue and it's constantly being broken down and rebuilt. And, you know, you've got cells called osteoblasts that remove older bone, you've got cells that build new bone. And throughout, you know, our reproductive years, these processes are balanced because estrogen is helping to regulate that balance. There are other processes as well, but I talk about estrogen because that's something that's going to impact every woman. Um, and as oestrogen sort of falls around, you know, during perimenopause and particularly early menopause, bone breakdown can begin outpacing bone formation. And therefore, your bone density declines, which is what's happened with me. And it's particularly important around the menopause transition because, as I mentioned before, you know, the average woman can lose up to around 10% of your bone mass in the first five years after menopause. So just think about that for a moment. 10% of your bone lost in the first five years after menopause. So you'll be in your 50s generally. Some women will be in their 40s. That's massive. Some women will even be in their 30s, actually, late 30s, if you go into early menopause. This is really important stuff. And you may not feel a single symptom while it's happening. I absolutely did not. And this is why I think we need to have conversations about this. We need to stop thinking about osteoporosis as something that happens to old ladies. You know, the fracture might happen at 70 or over, and that's I think why the funding for these tests isn't available until you hit that age group. But the foundations for that fracture risk have been developing decades earlier. Your 40s and 50s matter enormously when it comes to bone health. And the, you know, the thing is what's scary is you don't know what's happening. It doesn't hurt, uh, it doesn't ache. There's nothing. There's no real sense of anything going on in your bones. You don't feel your bones thinning, you can exercise, you can work, you can travel, you can feel great, and still be losing bone. And that's why osteoporosis is sometimes described as a silent disease, because often the first obvious sign is a fracture, as I mentioned. And that can be from like tripping on a step, you know, um, falling off a small height, putting your hand out to break your fall, um, or getting a vertebral fracture, which is obviously something I'm really worried about, um, because it can happen quite easily. And fractures can have enormous consequences as we age because they affect mobility. Mobility impacts independence, it impacts confidence, it impacts your physical activity and therefore your overall quality of life. Um, I don't want us waiting for a fracture before we start thinking about our bones. I want women thinking about bone health while you're still strong, while you're still active, while you have an opportunity to protect what you've got. So you might be wondering like, does everybody need a DEXA scan at 45? Look, it depends what at what angle you're coming at. Um I having had the experience I've I've had, I do encourage my clients, if they haven't had one and they're in their 40s and 50s, definitely 60s, I do encourage them to have a discussion with their GP as to whether or not that's appropriate for them. Um given you paying for it yourself, really, should there be an obstacle? If you're willing to pay for it yourself, I don't think so. But you know, that's not my scope of practice. Um and that this is the thing, the the Medicare rebate doesn't start till you're 70. So most GPs are not even going to think about it. Um, and it's probably not on the radar for most GPs, particularly if they're not in the field of menopause or perimenopause. So that's something to consider, and that's something I have now. Is I have a general GP that if I have a cold or not that I I just so rarely get sick, but I do have one if I need to, and I also have my menopause GP, and I see my menopause GP way more often than my other GP, just because um I don't ever get really sick. Uh so yeah, but I think it is worth considering having uh a qualified or not a qualified trained menopause GP on your healthcare team when you get in your 40s and beyond. Um,

Risk Factors And When To Test

SPEAKER_00 18:33

I guess some of the risk factors, I mentioned a few, some of the risk factors that your healthcare practitioner or you maybe want to think about, if you're thinking, well, maybe should I get one of these or not? Definitely the family history of osteoporosis. Absolutely. That's a no-brainer. A previous fracture from a relatively minor sort of accident or trauma. If you've had early menopause, so below kind of 45, if you've been low body weight for the majority of your life, or you've had a past history of an eating disorder where you've maintained a low body weight, that is a risk factor. Smoking is high alcohol intake, low calcium, if you've got vitamin D deficiency. And I've got to tell you, I test almost all of my clients for vitamin D, and I reckon easily 60 to 70% are vitamin D deficient. Um, if you've got celiac disease, that's an interesting one because it impacts your nutrient absorption. In fact, I had a client who was diagnosed with calcium, sorry, with uh celiac disease because on a blood test, her calcium was really low and her iron was really low, and so her GP uh arranged celiac testing, and there it was. So if you've got like a nutrient absorption issue, celiac disease is one of them, but it could be um inflammatory bowel disease, could be short bowel syndrome, could be a number of things. If you've had weight loss surgery, that can definitely, there's absolutely cases of terrible osteoporosis following weight loss surgery because of the fact that your appetite goes so low and your nutrient intake isn't ideal. And again, it should it's standard that people that have had weight loss surgery should be on a calcium supplement. And I've had a number of clients that have had the weight loss surgery then come to me for their nutritional plan and they've not ever been told they should be on a calcium supplement, so that's a big deal. Um, other risk factors are things like there are particular thyroid or parathyroid conditions that can impact calcium, rheumatoid arthritis, some medications, such as long-term corticosteroids, uh, certain breast cancer treatments. So it's other risk factors as well. There's a lot. So that's why an individual assessment matters. Um, and that's why you need to talk to your medical practitioner about it.

Calcium Vitamin D And Smart Supplements

SPEAKER_00 20:55

So I want to talk, I just touched on calcium supplementation then. So let's talk about that. It does matter. You know, the thing is when we talk about calcium, everyone thinks about milk. Everyone thinks about milk. But you know what? Yeah, there's some conflicting stuff about that. You can also get calcium from nuts, from leafy greens, from tofu, from there's plenty of foods. I'll go into some more foods later. Um, but calcium supplementation potentially depends on the person. Again, it's not something you should just go go and just go and grab some calcium supplements because you may not need them. And also there's things you've got to consider with calcium supplements, which I'll get into. Because the thing is the reason calcium is important with bones is bone actually stores our calcium. We use calcium in many, many uh biochemical reactions in our body every day. We use it in our heart, we use it like so many things we use. Calcium for and our bones store the calcium. So as we're using the calcium, that will come out of the bone into the area that it's needed. And I mean, we do have recommendations in Australia. I don't know what there are in other parts of the world. If you're listening to the podcast in other parts of the world, it'd be good to go onto your um wherever your nutritional advice comes from and have a look at that. But in Australia, we recommend for women over 50, 1300 milligrams of calcium per day, coming primarily from food. But this is where I want to add some nuance. Taking calcium isn't a complete bone health strategy. You cannot simply just take a calcium tablet every morning and think, okay, I'm done. I've protected my skeleton. Bone health depends on much more than one nutrient. Calcium is really important, but vitamin D is also important. Vitamin K, also important. You want to lay down that calcium into your bone, not your arteries. So if you're taking a calcium supplement and you are not taking vitamin K, you need to have a conversation with whoever's recommending that supplement for you. And if you're just taking it on your own, kind of because you saw an ad or you think you should because you're over 50, you need to have a conversation with someone who knows how to supplement properly because you absolutely need to be having vitamin K and vitamin D. Um, but the other thing that people often overlook is physical activity. That is one of the most important things you can do, is the physical activity. And it is heavy lifting because when you put stress on the bones, then that makes them stronger. But obviously, if you're someone like myself that has, I know for sure that my L4 two years ago was almost osteoporotic. So for me, I work with a personal trainer who can keep me safe, who I have absolute trust in. And that if you're in a situation similar to me, that's what I would highly recommend. Uh, because I do not want to get a spinal fracture. So heavy lifting is really, really important, but it must be safe. It must be safe for you. So it's super important to get advice around that. The other thing is hormones, muscle. Um, I will address these. So let's talk about muscle first because the other thing that happens in perimenopause, and this is something I really noticed, is muscle disappears very quickly. And I've had so many conversations with women, whether it's friends, whether it's clients, where they've said, you know, oh my God, I am doing everything I normally do in the gym, and my muscle is just not growing. And in some cases, it's going backwards. You actually have to do more when you get into your for most people, it's mid-40s. For some, it'll be earlier than that. But I really noticed my muscles just starting to disappear. And I remember my mum, even actually, she was on uh eight the old style of HRT for a long period of time, and she eventually got off it, and she said, Oh, my arms have just dropped. Like she said, her arms almost overnight just turned into skin rather than having any sort of tone. Um, so muscle is gonna deteriorate because of our hormones, uh, particularly our estrogen, dropping. And so you really do need to lift heavy to maintain that. And yeah, I'm gonna get into hormones a bit later. Um, so your overall nutritional status is really important. So instead of asking, should I take a calcium supplement, start by asking, am I getting enough calcium from my diet? And depending on you how you eat, that may come from some dairy, uh, but it could also come from calcium-fortified plant milks. Um, it may come from tofu, as I mentioned before, that's quite high in calcium. Tinned fish with edible bones, such as sardines, sounds a bit gross, but very effective. Numerous other foods, it's very easy to find these foods. You can Google or AI them. Um, but yeah, if you're feeling like, well, I'm actually, if you're drinking a lot of alcohol, if you're eating, uh drinking a lot of coffee is another one. If you're um living on Uber Eats or other meal delivery or takeaway, that's something that you probably need to either revisit. I would always, as a nutritionist, I would always say, let's get the food right. But sometimes supplementation is also just necessary and it's got to be the right one. I want to talk a little bit about vitamin D because it is calcium's partner. Vitamin D helps us absorb the calcium from our gut. Um, so you can consume plenty of calcium, but if you're significantly vitamin D deficient, that's gonna be a problem. And vitamin D is interesting because, unlike, well, firstly, vitamin D is actually a hormone. Can we get that right for start? It was really, it was mislabeled as a vitamin. But vitamin D is actually a hormone. That's why it's so important, that's why it has so many different roles in our body. But I'm only gonna talk about the bone role today. Um, and the thing is you probably know, unlike most nutrients or hormones, one of our major sources of vitamin D is sunlight exposure because it actually helps to activate the vitamin D, that skin exposure. And here in Australia, of course, and particularly Southeast Queensland where I live, we have another balancing act, which is you know, we need sunlight, but we also have very high rates of skin cancer. So I'm certainly not going to go and tell you to go bake yourself in the Australian sun. How much is sun exposure you need depends on the season, where you live, how your skin type, how much skin is exposed, your job, um so many things. And when you look in the research, there isn't actually a recommended length of time to spend in the sun to get that adequate vitamin D production and activation. So I kind of say to my clients, you know, you're looking at maybe 10 to 20 minutes of sun exposure. Generally, I would recommend going like earlier in the morning, later in the afternoon, um, with skin uncovered and without sunscreen. So it is a balance. And again, this will depend on your skin type. If you've got extremely fair skin versus being olive skinned, you know, you do have to balance up, you know, what's the skin cancer risk? How much sunlight can you actually tolerate before the risk of skin cancer goes up? So obviously, you do not want to burn. That's the number one. You do not want to be burning, that is not healthy. Um, but just getting 10, maybe it's 10 minutes twice a day, maybe it's 20. And I've always recommend areas that don't see a lot of sun. So maybe it's your upper thighs, maybe it's your belly, um, doesn't get a lot of sun during the day. That's probably the place that I'd be exposing to the sun because you know, um you just skin cancer is all about the hours of exposure. So if you've got areas of your body that never ever see the sun, they're the ones you should be putting out in the sun for a vitamin D kind of objective. Um, the other thing is to know what your vitamin D level is, because it is possible to have too much vitamin D. You can get toxic because vitamin D is a fat-soluble vitamin, so we store it in our fat tissue. So that is something that's also important, is I will very rarely supplement someone with vitamin D unless I know what their vitamin D level is. That's really important because that will also inform the dose. If I get someone whose vitamin D level is, say, 40, and I really want it to be closer to 100, I'll be supplementing at a much higher dose than someone whose vitamin D is 60 or 70. And also, if that will also inform my recommendation, is whether it's winter or whether it's summer. So again, personalized healthcare. This is what it's about, not blanket recommendations. I also wanted to touch on exercise. One of my favorite parts of this conversation actually is exercise because bones respond to load, as I mentioned. The skeleton

Training For Strong Bones And Muscle

SPEAKER_00 32:26

needs a reason to say stay strong. Our human our amazing human body is so adaptable. So if we're sitting in a chair all day, if we're driving, we're sitting, sitting, watching TV at night, your skeleton doesn't really need a reason to stay strong. Your muscles don't need a reason to stay strong and toned. So if you're not using it, that old adage, if you're not using it, you're losing it, and this is what's happening. So when you place an appropriate stress through bone, the body receives a signal that those bones need to be uh capable of handling that load. And that's one reason resistance training is so important as we age. So weight training, resistance training, weight-bearing activities. Walking is amazing. Can you please keep walking? It's because it's brilliant for your cardiovascular health, mental health, metabolic health, and general well-being. But if your entire bone health strategy is a gentle walk around the block every day, we can do better. Your bones benefit from being challenged, and your muscles need to be challenged too, because strong muscles will protect your bones and they improve balance and stability. They help catch ourselves, help us catch ourselves if we trip. They reduce our risk of falling in the first place, which is why bone health and muscle health are really inseparable. And I don't want women just simply avoiding osteoporosis. I want to see us becoming strong. I want to see you carrying your own suitcase when you're 70, getting yourself up off the floor when you've gotten down there to do some yoga, uh, climbing the stairs easily, traveling, gardening, playing with grandchildren if you have them, living independently, not in, you know, a situation where you need uh support to be living, doing the activities of daily life. The goal isn't a pretty DEXA number, it's a physical freedom, and that's what we're really protecting. And just while we're on this sort of movement, if you're not in a in a position where you can do weight training, even jumping, like if you can't afford a train, I'm fortunate I can, I'm, I've got a personal trainer and I prioritize that. You know, since I um found out I have osteopenia, I prioritize my training big time. Uh, and I've made a lot of changes in my lifestyle, which means I'm saving money in other areas and I put all of that towards my training. Um, but things you can do if that's not available to you, are jumping, having a jumping practice, which I know sounds a bit crazy, but literally jumping up and down on the spot 20 times a day will help. Dancing, you can dance around your living room, whether it's whether you've got some mobility issues with make which may make that difficult, just slowing, slowing it down, but enough so you've got a little bit of impact on the bones, that will help. Brisk walking, brisk walking to the level where you can only just hold a conversation, that's super helpful. So it's not just and body, sorry, body weight, that's the other thing I wanted to mention. So squatting your body weight, doing push-ups if you can do push-ups, or doing things where you're picking, picking your furniture up and down in a safe way. I will always say, please, if you don't know how to lift heavy things properly, then yeah, you gotta be super careful because you don't want to end up with an injury from trying to do this. You need to be doing this all in a safe way. Um, if we talk a little bit about more about nutrition and talk about protein, you know, of course, protein is important. Um, I feel sometimes like I manage to talk about protein on almost every episode, but there's a reason. You know, protein is essential for maintaining muscle, and bone itself also contains a substantial protein matrix. So it's really important as we kind of move along our 40s, 50s, and 60s and beyond, preserving muscle really is a big goal and it becomes increasingly, increasingly important. Uh, and one of the biggest mistakes I see women make when they're trying to lose weight is dramatically reducing their food intake. They eat less, and this is what we're seeing with the weight loss injections. People are eating a lot less uh and they're losing muscle and they're losing bone. We're seeing a lot of this at the moment. Uh, so yeah, as you eat less and less and less, the scales might go down, and that might make you feel happy. Um, but weight loss isn't automatically fat loss. If you're losing muscle at the same time, that's not a great place to be, particularly in this time of life. You need to be thinking well beyond how small can my weight loss go, how small can my weight be, and more how strong can I become? It's a completely different goal. It's a much healthier conversation for women as we age. And it is certainly, as far as I'm concerned, with the way I work with women with weight loss, that's what we do. We aim to uh preserve muscle mass and prioritize fat loss. And it's super important. And you're not gonna get that just from calorie restriction, you're not gonna get that from fad diets, you need proper personalized nutrition to do that. So I do want to just talk a little bit now about menopause hormone therapy, which is we now abbreviate as MHT. We no longer refer

MHT And A Personal Bone Health Audit

SPEAKER_00 37:50

to as HRT. So MHT menopause hormone therapy. We really can't have a conversation about bone health in our 40s, 50s, and beyond in that period and post-menopause phase of life without talking about it. Because estrogen does protect bone. So replacing estrogen through MHT can help maintain bone density and reduce fracture risk. As you know, you can't generally just have oestrogen unless you don't have a uterus anymore. That's different. But if you still have a uterus, then you also need progesterone to protect the uterus. And also, there's some pretty good data for testosterone replacement as well to support bone health. And so, you know, MHG, we tend to think about for women who are experiencing menopause symptoms like hot flushes, like night sweats, like brain fog, all those sorts of things. And it's obviously very much an individual decision. It's not appropriate for everyone. Unfortunately, not everyone can take it for other medical reasons. Um, medical history really matters when it comes to this. There may be personal risk factors that also come into. So, this is why it's a conversation to have with a GP or a menopause, generally, I would always recommend a menopause-trained doctor who can assess the benefits and the risks for you personally. And, you know, you don't need to wait until you have osteopenia or osteoporosis and then worry about it. Bone health should be part of the menopause conversation way earlier than that. So if you're already discussing MHT with your doctor, bone health is one of the factors worth including in that conversation. Um, now something I do really want to emphasize. We're starting to come to the end of the pod. Uh, what I do want to emphasize is osteopenia does not mean osteoporosis is inevitable, which makes me very happy, obviously. If you've had a DEXA scan and been told you have osteopenia, this does not automatically mean, well, okay, I'm gonna get osteoporosis and life is over. Uh no, osteop osteopenia is information, it's an opportunity. It's an opportunity to say, all right, okay, my bone density is lower than I'd like it to be. This can impact my life long term. So what are the factors I can address? So maybe it's your calcium intake, maybe you need your vitamin D tested, maybe you need to actually instead of thinking about doing some weight training, actually doing some weight training. Um, maybe there's another underlying medical condition that's contributing to this. So that's again why your doctor needs to be involved. Maybe there's a medication you're on that perhaps needs to be reviewed. Um yeah, the approach really depends on the individual. So it is something that if you had get that diagnosis, there is there are things you can do and you do want to act immediately because this is a warning, and warnings are incredibly useful when we actually act on them. So let's come back to where today's episode started, my DEXA scan today. And as I'm sitting here, or standing here actually at my stand desk recording this, I genuinely don't know what my results are going to show. I'm really, really hopeful that because I've instigated so many changes focused on my bone health. I am very hopeful, but you know, I don't know what it's going to show. And that's really why I wanted to record this episode now rather than waiting, because I don't want this to be, oh, look what I did and look at my perfect results. Because that's not real life. I've had two years between scans. I've made choices during that time that I hope have supported my bones to the best of my ability. But biology is biology. Um, I'm really interested to see what's happened. I'm not perfect. I know that, you know, if it hasn't improved as much, like I want it to be normal. But even if it's just improved, then I know, okay, I really have to double down and close any gaps that I might have in the choices that I'm making. Um, I'm yeah, I'm super interested to see where I'm at. And when I receive the results, I'll compare them and so will my GP, compare them with my previous scan. And rather just looking at, you know, am I still osteopenic? I want to know has my bone density improved? Has it remained stable? Which vertebrae are impacted now? Um, particularly in my spine. What's my hip looking like? Hopefully it's not osteopenic, which is not at the moment. And what does that mean for what I do next? Because this is what proactive healthcare looks like to me. We measure and then we intervene where appropriate. Then we reassess, then we adjust, not from fear, but from information. So I'd love for you to do something after today's episode. And it's not book a scan necessarily. Just have a little bone health audit for yourself and just to ask yourself, you know, am I doing what am I doing? Am I doing any resistance training? And unfortunately, a Pilates class is not necessarily going to cut it. It's got to be really quite heavy. Um, am I doing appropriate weight-bearing activity? Am I eating enough protein? Am I, do I know whether I'm getting enough calcium? What are the calcium foods in my diet? Do I know my vitamin D status? Are you a smoker? Maybe that's, you know, I know there's many reasons to stop, but maybe now there's another reason. Am I regularly drinking more alcohol? That is good for my bones. What's the family history? Have I had a fracture from a relatively minor trauma? Have I had uh early menopause? Am I taking any medications that could affect bone health? And most importantly, have I ever discussed my bone health from my healthcare provider? Because generally they're not going to bring it up with you. Um, if the answer is no, then maybe that's the action you can take from today's episode. So I want to finish with something that I think sums up why this conversation matters so much. Because we spend an enormous amount of time in our 40s and 50s and beyond worrying about what our bodies look like: our stomach, our thighs, our arms, our wrinkles, our weight. But how good would it be to spend at least as much time thinking about what our bodies will allow us to do? Because one day the number on the scales won't matter nearly as much as whether you can climb a staircase, carry your groceries, lift a suitcase, get off the floor, walk confidently without being afraid of falling. Go traveling, live independently, and keep doing the things that make your life yours, that make your life happy. And that's why bone density and bone health matters. Not because we want perfect DEXA scans, because we want strong bodies that carry us through long, active, incredible lives. And the beautiful thing is we don't have to wait until we're 70 to start protecting that future. We can start now in our 40s, in our 50s, in our 60s, during perimenopause, menopause, and beyond, we have that power. So I will absolutely share what happens with my own DEXA results once I receive them. Because I'm just as curious as you maybe you are, maybe you're not really, but you know. Uh

Share The Conversation And Wrap Up

SPEAKER_00 45:46

if today's episode has made you think about this for yourself, or maybe made you think about another woman in your life, please share this episode. The more women are sharing and talking and opening conversations about this, the healthier we are all going to be and the happier we are all going to be as we age in a way that really makes our lives fun, exciting, and what we want them to be. So thank you for spending this time with me today. Um until next time, eat well, live something heavy, look after the body you're going to be living in for decades to come. Uh and yeah, I will see you next week. Hopefully, I will have my results by then. Thanks so much for joining me on the Ageless and Awesome podcast. If you would like this episode, please make sure you click the little plus button if you're on the podcast, or the follow button if you're on Spotify so that you get each new episode delivered to you every single week. If you feel like writing me a five-star review, it would absolutely make my day. If you found this episode resonating, head over to my Instagram and DME at the Perimetapor. I would love to connect with you.