Researchers weigh in: Thin women more likely to experience rapid bone loss in menopause transition

I have shared with you my experiences how thin and worried women often have lower bone mass and tend to lose more bone during the menopausal transition.

But there is still much we can learn about this connection. In fact, I have become so interested in this phenomenon that I recently began my own “Thin Women and Bone Loss” research project.

And researchers around the world are interested in this topic too.

Recently, one Chinese study focusing on bone loss during premenopause, perimenopause, and post-menopause had the novel aspect of looking at how weight and body mass index predicted the likelihood of rapid bone loss during the menopausal transition. In the study, women weighing less than 110 lbs. had 5.5 times the risk of rapid bone loss than women who weighed more than 110 lbs. Among all risk factors,only body weight and body mass index were significantly different between those with rapid bone loss and those with normal bone loss. Thin Chinese women clearly lost more bone during the menopause transition.

These findings were part of a 2010 study following 161 Chinese women, ages 45-55, for five years. During that time, most moved from premenopause into perimenopause and post-menopause. Researchers also found that among these women the most rapid rate of bone loss occurred during the perimenopausal stage of the menopausal transition. This tendency towards rapid bone loss during perimenopause has also been documented among Caucasians by endocrinologist Dr. Jerilynn Prior and others.

Here at the Center for Better Bones we have found both aspects of the study to be true for Caucasians, but our standard for “thin” is more like being less than 120 lbs. We have found thin women who worry excessively seem to undergo more bone loss than those who do not have such a strong tendency to worry.

With the body of research growing about the connection between weight and bones, I want to encourage women — from premenopause and beyond — to remember they can make a measurable difference in their bone health with a comprehensive approach that includes the proper diet, exercise, and supplements.

I look forward to updating you on my research project!



Cora, H et al. 2010. Body weight but not serum C-telopeptide predicts rate of bone loss during the menopausal transition. ASBMR poster presentation M00339, Toronto.


How can you improve your body by improving your bones? Heart health!

iStock_000017473165XSmallThis is the last blog in my series of “How can you improve your body by improving your bones?” As you’ve seen, the health of your bones is fundamental to your health as a person.  And there’s one more important part of your body to consider — your heart.

We see a clear link between bone health and heart health

The correlation between bone health and heart health is so high that those with osteoporosis may benefit from screening for cardiovascular disease.

In a natural Better Bones approach, everything you do for bone will also help your heart. A Better Bones program will include a full complement of the vitamins, minerals, antioxidants, and essential fats for building cardiac strength, as well as sufficient amounts of vitamin K — particularly K2 as  MK-7 — to reduce the risk of arterial calcification.

Further, following a diet high in vegetables, fruits, nuts, and seeds, as well as whole grains is associated with lower markers of inflammation in the blood, such as homocysteine and C-reactive protein, both of which are risk factors for heart disease as well as for osteoporosis.

Which leads me to the grocery store…

When I see the processed, high-sugar, high-sodium options, I am reminded how my friends from other countries like to take pictures of our US supermarkets — complete with an entire aisle of boxed cereal or crackers in all shapes and sizes.

On your next trip to the grocery store, focus on foods that can not only help you preserve bone and muscle, but also achieve optimal blood pressure. Fresh vegetables, fruits, nuts, and seeds yield a high-fiber, low-sodium diet which both preserves bone and helps maintain normal blood pressure.

These foods are included in two important and well-researched diets: Nature’s alkaline diet, and the DASH Diet (Dietary Approaches to Stop Hypertension) from the National Institutes of Health which is the leading dietary approach to reversing hypertension.

Further, these diets include many nutrients key to bone health, which are instrumental in regulating healthy blood pressure:

  • Calcium
  • Magnesium
  • Vitamin D
  • Potassium. This is an especially powerful heart and bone guardian. It helps maintain healthy blood pressure, electrolyte balance, bone-crucial acid-base balance, and calcium levels.

I’ve made an alkaline diet the centerpiece of my Better Bones Health Package not just because it supports bone health, but because it supports overall wellness too.


How can you improve your body by improving your bones? Part 1

iStock_000006376735SmallWhen I wrote my book Better Bones, Better Body, I wanted to make the clear, simple point that everything a person does to support bone health is going to help support their overall health. But every now and then, I like to get specific about how true it is that bone health is fundamental to total health. So here’s one quick example:

Supporting bones helps improve metabolism and may prevent heart disease & diabetes

When I tell most people a bone health program helps reduce risk of cardiovascular disease and diabetes, they assume it’s because exercise is such an important part of bone building. That’s partly true, but it’s far from the only reason.

Simply put — the bone building process helps lower your risk of obesity and related diseases, including diabetes. This is because our skeletons aren’t simply the support structure for movement — they also produce bone hormones. During normal bone building, the hormone osteocalcin is produced, which helps keep blood sugar and insulin sensitivity at healthy levels while simultaneously reducing fat stores. In fact, research shows that many people with Type 2 diabetes also have low osteocalcin levels, which been suggests that helping people with diabetes to produce more osteocalcin could become a way of improving their health.

You don’t get these same cardiovascular and metabolic benefits from bone drugs

Commonly used bone drug therapies generally suppress bone turnover and thereby limit the production of osteocalcin — which, of course, may have implications for the long-term cardiovascular and metabolic health of the people taking these drugs. Another reason why a life-supporting program of alkaline diet, exercise, and stress reduction should be the first step when addressing bone loss!

In upcoming blogs, I’ll share even more ways how better bones help lead to a better body and overall health.  Stay tuned!


[No author listed.] 2009. Research shows skeleton to be endocrine organ. Columbia News. URL: (accessed 05.07.2009).

Wolf, George. Energy regulation by the skeleton, Nutr. Rev., 66(4):229-233

Bouillon, R., & Decallone, B. 2010. The white adipose tissue connection with calcium and bone homeostasis. J. Bone Miner. Res., 25 (8), 1707–1710. URL (abstract): (accessed 02.15.2011).

Lee, N., et al. 2007. Endocrine regulation of energy metabolism by the skeleton. Cell, 130 (3), 456-469. URL: (accessed 05.07.2009).

Kanazawa, I., et al. 2009 Serum osteocalcin level is associated with glucose metabolism and atherosclerosis parameters in type 2 diabetes mellitus. J. Clin. Endocrinol. Metab.,  94 (1), 45-49. URL: (accessed 02.15.2011)


Bone density testing biased: thin, small women take note

iStock_000005041988XSmallso called “bone density tests” do not truly measure bone mineral density. This is because bone density machines are highly influenced by area or size. For example, small-boned or thin people are likely read as having lower bone density than they really have.

I was excited to see two different research projects looking at bone density cross-culturally to confirm this theory.

  • The first study looked at bone density of premenopausal and perimenopausal women in the US from four different ethnic groups — Caucasian, African-American, Japanese and Chinese. Although simple bone density measurements found striking differences in bone density between women of different ethnic backgrounds, among women of comparable weight there were no differences found in lumbar spine BMD (bone mineral density) in African-American, Chinese, and Japanese. BMD of the hip bone in women of similar weight was also similar in Chinese, Japanese, and Caucasians. When compared by bone size, Chinese women were found to have a lumbar BMD equal or above those of Caucasians and Japanese women.
  • The second study compared the bone mineral density of Chinese, Indian, European, and Polynesian women living in New Zealand. The commonly measured BMD of these ethnic groups showed Chinese and Indian women having significantly lower BMD than Caucasians, but the European women were taller. When the numbers were adjusted for height, the differences in bone density between Caucasians, Indians and Chinese were almost completely eliminated. Polynesian women presented a different case. They were significantly more obese and had a higher bone mineral density even after adjustment for body size.

The take home message is that bone and body size, height and weight make a difference in bone density testing, and current bone density testing underestimates the bone density of thin or small individuals. One day we will see bone density tests better adjusted for these variables. In the meantime, if you are thin, small boned, or short, expect that your bone density measurement may likely show lower densities than larger and heavier women of your age group.

Learn for yourself what you test results mean with my new DVD, “How To Read Your Bone Density Test.”



Finkelstein, J., et al. 2002. Ethnic variations in bone density in premenopausal and early perimenopausal women: effects of anthropometric and lifestyle factors. J of Clin Endo & Metabol, 87(7), 3057-3067. URL: (accessed 10.27.2010).

Cundy, T, et al. 1995. Sources of interracial variation in bone mineral density. J of Bone Min Research, 10(3), 368-373. URL: (accessed 10.27.2010).

Yes, you can be too thin

Whenever I go to one of my son’s school events, or see a group of children in other places, my attention is drawn to the number of very thin, almost frail looking young girls. The anthropologist in me always asks, Why would nature select for such thin, small boned girls? The thin children, I muse, cannot possibly have the same degree of bone strength as the sturdier girls. Will they not in later life fracture more than others?

I’ve asked myself this question dozens of times. Here at the Center for Better Bones we’ve seen that being underweight, and particularly losing more weight as we age, is a significant risk factor for osteoporotic fracture. But now, new research suggests that thinness in childhood is also a critical issue. A large study from Finland has confirmed my speculation. This investigation found that, as they aged, the thinnest Finnish children had more than an 8-fold increased risk of hip fracture as compared to the heaviest group of children. Yes indeed, you can be too thin.

OK, so now you might say that’s all well and good but what about obesity? Does being very overweight help or hinder bone? Well, we don’t have data on children right at hand, but we do have research findings on adults. Recently, Italian scientists asked if obesity offered protection from osteoporosis. In a study of middle-aged women and men they found that being overweight was neutral or protected for bone mineral density. However, being obese was associated with low bone mass, often compatible with a diagnosis of osteoporosis. Their conclusion is that skeletal metabolism is likely to be altered by factors related to obesity. Yes indeed, being really heavy does not help bone either.

Research shows us that obesity is related to many health issues, and that losing weight is often beneficial to our health. When it comes to your bones, this issue is a bit more complicated. I always encourage women to take care with weight loss, especially as they age, because the combination of low weight and advancing age are important risk factors for determining low bone density. We all have a healthy weight at which our bodies thrive, and it’s always best to work toward yours. If this means you have to lose a few pounds, do so with your bones and whole body in mind:
• Exercise in a way that builds muscle
• Strive for an alkaline diet
• Supplement with bone-building vitamins and minerals, especially vitamins D and K


Javaid, MK, JG Eriksson, E kajantie, et al. 2010. Growth in childhood predicts hip fracture risk in later life. Osteopor Int, DOI: 10.1007/s00198-010-1224-3, Pub. online April 9.
Greco, EA, R Fornari, F Rossi, et al. 2010. Is obesity protective for osteoporosis? Evaluation of bone mineral density in individuals with high body mass index. Int J of Clin Prac, 64(6):817-820.


Why should you hang on to your medical records?

Let me tell you about Janet. Janet is a thin, energetic 57-year-old woman now seven years into menopause who came to the Center for Better Bones for the first time last week. Upon sitting down the first words out of her mouth were, “My doctor has told me that I have the bones of an 80-year-old and that I could fracture just picking up a heavy bag of groceries. I was told I had to take an osteoporosis drug, but I have friends using these drugs. I know about their potential negative effects, and I really don’t want to take one. The doctor has scared me to death. Can you help me?”

The first step in helping Janet was to do a complete assessment of her health situation and circumstances. Janet’s answers to my questions about her health and medical history were imprecise. While she had been given three bone density tests, she only had one in her possession. She knew that she taken some calcium and vitamin D on and off, and she recalled using hormones a year or so after menopause, but did not know exactly what she took, or for how long. She had used a steroid inhaler for bouts of asthma a few times over the last two decades, but she wasn’t sure about the dates or medication dose. She was recently tested for vitamin D, but did not know her level; she was just told that it was “normal.” Further, at one point her doctor mentioned her thyroid levels were a bit high. Her medication dose was lowered, but she did not know if a retest had been done to make sure the new dose was correct.

While Janet’s fear of the situation was vibrant and clear, her recollection of the circumstances leading up to it were not. Now we had to reconstruct her history to determine if she was actually losing excess bone, and if so, why.

After considerable effort on both our parts, we were able to conclude that Janet need not be scared. She did not have the “bones of an 80-year-old”, and her 10 year fracture risk was low. Here’s what we found:

• She lost 8% of her bone mass during her menopause transition, which is exactly what the average North American woman loses during. In her case, the loss looked worse to the doctor because she was thin and started menopause with a low bone density reading. As I have mentioned before, bone density machines measure area rather than density and thin folks with small bones come up with a lower “bone density” reading.  This need not be a great concern if bone loss is not on-going.  In Janet’s case, six months into the Better Bones Program her bone resorption (NTx) test showed she had halted her menopausal bone loss.
• The report of a normal vitamin D level (which was barely the 32 ng/mL needed to absorb adequate calcium) came from a blood tests taken in the late fall while taking 1,000 IU of vitamin D. We knew by midwinter she would be vitamin D deficient if she didn’t increase the vitamin D intake well beyond the 1,000 IU.
• Analysis of her thyroid tests over time revealed that for a period she was given excess thyroid medication and this might well have accelerated bone loss.
• Unexpectedly, her C-reactive protein test (a non-specific marker of inflammation) was high, indicating that she may well be undergoing an inflammatory process and in need of higher levels of antioxidants.  Proper supplementation corrected this additional fracture risk.

“Take Heart and Take Action” is my favorite motto. In this case, the “action” pertains to you and your medical records. If Janet had been tracking her own lab results, she would have been informed all along and subsequently less scared and shocked when her doctor gave her the news about her bones.

• Keep copies of your medical records
• Get copies of your medical test results
• Take the time to chart out the changes over time.


Bone takes a hit from smoking

It has long been suggested that smoking is directly toxic to bone, but the extent to which smoking increased fracture risk was uncertain. Now, a recent meta-analysis of studies from all over the world has found that smoking is associated with a significantly increased risk of hip and other osteoporotic fractures in both men and women. After adjusting for age and weight, the risk of hip fracture, for example, was 55% higher in smokers than in non-smokers.

Looking at the impact of smoking in another way, researchers Law and Hackshaw reported in 1997 that one hip fracture in eight is attributable to smoking, regardless of other risk factors.


Kanis, J.A., et al. 2005. Smoking and fracture risk: A meta-analysis. Osteoporos Int, 1(2), 155-162.

Law, M.R., Hackshaw, A.K. 1997. A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: Recognition of a major effect. BMJ, 315, 841-846.


How to tell if you are losing bone without a bone density test

While most doctors tend to monitor bone density with the dual-energy x-ray absorptiomentry (DEXA) test, there is another, less expensive test helpful in determining if you are currently losing bone. This test, called the cross-linked N-teleopeptide (or NTx for short), is a simple urine or blood test known as a “marker of bone resorption.” When you lose bone, small fragments of bone protein show up in the urine and blood, and measuring these bone protein fragments gives an indication of rate of bone breakdown. In most cases a high rate of bone breakdown, also known as bone resorption, indicates that there is an ongoing loss of bone mass.

The bone resorption markers most commonly used are the urine NTx osteomark marker and the urine deoxypyridinium cross-links (Dpd). Your physician can order either of these tests. Generally, a score that’s near or even a bit below the premenopausal mean for women, and one near or even a bit below the young adult mean for men, is ideal. In both tests, the higher the number, the greater the likelihood of a more rapid rate of ongoing bone loss. For more details see my articles on bone density testing and bone resorption testing.