Osteopenia? 5 steps for stronger bones


If you’re among the millions of people who’ve been told they have osteopenia, I know it can be confusing and scary. But you’ve come to the right place.

I talk all the time with women wondering what to do next when they get diagnosed with osteopenia.

I always start with this:

Osteopenia does not mean you will always suffer from osteoporosis or a fracture. Osteopenia means that your bone density measurement is less, but not excessively less, than a woman who is 30 years old. And what that really signifies for you will depend on your individual body type, lifestyle, history and many factors you can take control of right now.

5 steps to build stronger bones

Here’s what you can do to make sure your bones are getting everything they need to stay strong.

1. Get the correct amount of key bone building nutrients.

  • Eat a wholesome alkaline diet and try high quality nutritional supplementation. Be sure the supplements you use are designed to alkalize so they spare both bone and muscle.
  • Make sure your mineral intake is adequate. This can be easily done by measuring your first morning urine pH. A first morning urine pH reading of 6.5 to 7.5 suggests you’re obtaining adequate minerals from your diet and supplements.
  • Test your vitamin D level and supplement with enough to reach a 50 to 60 ng blood level all year round.

2. Build muscle strength. Chronically low muscle mass is associated with low bone mass. Even stronger grip strength and stronger back muscles are associated with higher bone density. If you have been told you have osteopenia in the hip, try to walk more, hop, do heel drops, and jump if you can. All provide bone-stimulating impact to the hip. Also consider using a weighted vest when walking. It makes each step deliver a greater bone stimulating impact to hip.

3. Avoid bone depleting anti-nutrients. The list is long so you might have to pick away at bone depleting anti-nutrients little by little. High on the list are excessive alcohol (more than two drinks a day), smoking, colas, excessive caffeine, and high sugar intake. Many drugs and medications damage bone and the list seems to expand daily. Steroid drugs such as prednisone rank as the top drug bone-busters, causing roughly 20% of all osteoporosis in the U.S.

4. Eat enough wholesome food daily. The body is one single unit; if you lose weight you lose bone. The bone weakening from weight loss before menopause is more easily compensated for than that from weight loss after menopause. Make sure you get between 50 and 80 grams of protein daily, depending on your physical activity level.

5. If needed, work with your doctor to see if there’s any medical cause for osteopenia. If you have ongoing excessive bone loss as measured either by sequential bone density testing or by a bone breakdown marker test such as the NTx , or if you have experienced a low-trauma fracture, steps should be taken to detect hidden causes of this bone loss. My Medical Osteoporosis Workup details the most common tests used to detect hidden secondary causes of bone loss. You might share this document with your health practitioner and see which tests they will do looking for your hidden causes of bone loss.

As you can see, you aren’t powerless when it comes to building stronger bones — even if you’ve been diagnosed with osteopenia. Consider this a window of opportunity to make some nutritional and lifestyle changes. My Better Bones Builder Program is a great place to start, because it puts everything together for you.


Read more:  What does osteopenia really mean?

See why osteopenia doesn’t always mean you’ll suffer from osteoporosis or fracture — or that you will need a bone drug.



Alonso-Coello, P et al. 2008. Drugs for pre-osteoporosis: Prevention or disease mongering? BMJ 336:126.  DOI: https://doi.org/10.1136/bmj.39435.656250.AD

Looker, AC et al. 2010. Prevalence and trends in low femur bone density among older U.S. adults: NHANES 2005–2006 compared with NHANES 111. J Bone Miner Res  25 (1):64–71.

Petersen, BA et al. 2017. Low load, high repetition resistance training program increases bone mineral density in untrained adults. J Sports Med Phys Fitness 57(1–2):70–76.

6 ways standard osteoporosis treatment is dead wrong: Part 2


I’ve written recently about two of my top six concerns about the standard approach to bone health.  And now, here are two more that emphasize how women are often being misled about how to best protect their bones:

3. Contemporary osteoporosis management treats bone as if it were separate and isolated from the rest of the body

It’s tempting to look at the body the way we look at cars — as a collection of independent parts, each with a specific job. But that’s not what the body is! It’s a set of dynamic, interconnected systems that are constantly changing in response to what goes on around us and inside us.

While most people lose some bone as they age, bones don’t just “wear out” over time, the way a car’s parts do. If bones are weak or rapidly become thin, it’s nearly always because of a larger systemic problem in the body. The most effective approach in this situation is a big-picture perspective that looks at bone health as an indicator of overall health — it’s been shown that older adults who experience a hip fracture have lower baseline health-related quality of life than those who don’t.

But the standard approach is to focus on the mechanics of bone breakdown and interfere with them. Most bone drugs work by targeting the cells that break bone down and stopping them from doing their job. Doing this doesn’t actually solve the problem — it just masks the effects.

Enduring bone health requires rebuilding strength and vitality. That’s why it makes sense to look at the complete body system — circulation, bone, acid-base balance — to find the places where something isn’t working right to cause bone loss, rather than focus in on halting bone loss itself, which is most often an effect of a larger problem.

4. High-dose calcium is still considered the first-line treatment, yet it does not prevent fracture, and may be harmful

Speaking of “larger problems,” let’s take a look at what happens when you try to address fracture risk with calcium supplements. There is tremendous controversy about calcium and bones, but now it’s becoming clear that high-dose calcium supplementation is not the solution.

Multiple studies show that calcium does not decrease fracture risk except in those with a very low calcium intake — and some studies suggest that taking high-dose calcium supplements can lead to an increase in arterial calcification, stroke, kidney stones.  In my own research, it’s quite clear that while adequate calcium is needed for healthy bones, using high doses is counterproductive.

It seems wise to obtain the total 1,200 milligrams of calcium daily from diet and supplements as recommended by the National Institute of Health. At the same time, we recommend you also learn about the other key bone nutrients and make sure you obtain adequate doses of all these essential bone builders.

Stay tuned for next week’s blog for my final two reasons the standard approach to bone health doesn’t make sense. And as you’ll see, are far less effective and far more risky than commonly thought!

See Part 1 here.



Randall, AG et al., Deterioration in quality of life following hip fracture; a prospective study osteoporosis international 2000, 11(5);460-6.

Bischoff-Ferrari HA, et al., Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials. Am J Clin Nutr. 2007

Bolland MJ, Leung W, Tai V, Bastin S, Gamble GD, Grey A, Reid IR. Calcium intake and risk of fracture: systematic review. BMJ. 2015;351:h4580. doi: 10.1136/bmj.h4580.
Bolland MJ, Grey A, Reid IR. Calcium supplements and cardiovascular risk: 5 years on. Ther Adv Drug Saf. 2013 Oct;4(5):199-210. doi: 10.1177/2042098613499790

* Information presented here is not intended to cure, diagnose, prevent or treat any health concerns or condition, nor is it to serve as a substitute professional medical care.

6 ways standard osteoporosis treatment is dead wrong: Part 3

In my previous two blogs, I’ve given you 4 important reasons why I don’t believe standard osteoporosis treatment is effective. In this final blog of the series, I want to emphasize that there is no magic bullet for optimal bone health – despite what you may have heard about calcium or bone drugs.  Here’s why:

5.    The calcium-centered focus has distracted us from the fact that at least 20 nutrients are essential for bone health

I’ve pointed out that calcium doesn’t reduce fracture risk and excessive calcium intake holds increased risk of cardiac problems. But if calcium isn’t the “magic bullet” for bones, what is? Well for one thing, adequate vitamin D levels are essential, and  a lot of doctors are finally realizing how important vitamin D is for bone health.

Yet too little attention is still paid to other essential bone nutrients — especially vitamin K, which makes a major contribution to bone health and supports many other systems as well, but also zinc, magnesium copper, boron, folate, manganese and vitamin C.

6.    Bone drugs are far less effective and far more risky than commonly thought

Here’s where it really becomes frustrating. Our health system pushes high-dose calcium (which doesn’t work) as the solution to low bone density (which is not necessarily the problem). Then when there’s no improvement in bone density from overloading the body with calcium, the typical next step is to prescribe a bone drug.

I’ve always maintained that such medications should be used only as a last resort, for very severe cases where drastic measures are needed — for instance, a person experiencing low-impact fractures or excessive, uncontrollable bone loss. This is not the situation for most people who have relatively low bone density .

With that in mind, it shouldn’t be surprising that the results of bone drug therapy are often  very disappointing. Even worse, the evidence suggests no benefit from bisphosphonate bone drugs on real-world hip fracture incidence. Nor do these drugs benefit people 80 years old and older — which is, of course, the group most likely to fracture a hip!

What it all boils down to is this: If we’re to really help people to live long, healthy lives free from the fear of bone fractures, we don’t need more bone drugs.  Instead, we need to change our approach by:

  • Carefully assessing each individual case to identify whether excessive bone loss or weakness exists;
  • Detecting and correcting both obvious and hidden causes of excessive bone weakening;
  • Broad-spectrum, whole-body support with nutrition, exercise, neuroendocrine and hormonal balance, stress reduction, and resilience enhancement.

Such an approach would limit bone drugs to the few specific situations where obvious bone weakness cannot be offset by natural means and requires heavy-duty intervention.

Missed the previous blogs?  Read more.

Part 1

Part 2

* Information presented here is not intended to cure, diagnose, prevent or treat any health concerns or condition, nor is it to serve as a substitute professional medical care.

6 ways standard osteoporosis treatment is dead wrong: Part 1


It’s no secret that I’m not a fan of the way bone drugs like Prolia® and Fosamax® are used these days. But people sometimes misinterpret my thinking as being “anti-drug” — yet it’s not just the drugs I object to. It’s how medicine in general approaches bone health and fracture risk.

I have at least 6 major objections to the standard approach, but for the sake of brevity, we’ll look at them two at a time over the next three weeks.

1.    Treatment is based on bone mineral density — but bone mineral density does not predict fracture

Having a low-side bone density isn’t actually a health problem. It doesn’t hurt or limit mobility — it doesn’t even necessarily mean the bones aren’t strong! It’s only when you fracture a bone that you have a health problem — and more, you cannot predict fracture by bone density alone. In fact, the majority of people whose bones are so fragile they experience a low-trauma fracture do not have an “osteoporotic” bone density.

That’s why treating low bone density bones as a “disorder” that “needs to be addressed” with heavy-duty medications makes no sense. Weak bones, on the other hand, need intervention. And, as far as weak bones go, there’s almost always an underlying problem causing the depletion of bone strength — whether it be nutritional, hormonal, bone-damaging medications, or some other hidden health condition or lifestyle factor. Properly detected and corrected these underlying causes can greatly reduce the risk of fracture. This is why a real fracture risk assessment and an assessment of underlying causes are so critical to developing a comprehensive bone-building program.

2.    The standard medical approach to osteoporosis is fear-based — and fear actually damages bone

Given that a low-side bone density does not necessarily indicate weak bones, why do you suppose doctors are so adamant that people with a low-side bone density need treatment? They’re afraid their patient will have a serious fracture.

But fear of fractures is itself bone damaging and can be a self-fulfilling prophecy — literally, as studies have linked higher levels of stress and the stress hormone cortisol with osteoporosis and increased fracture risk. A recent Danish study, for example, showed that just the perception of stress — seeing yourself as stressed — increases risk of osteoporotic fracture by 68%. It is bad enough that we have so many reasons to fall into stress and worry, we really do not need our health professional piling on more stress with unfounded fears of fracture. Again, what’s needed is a fracture risk assessment leading to a comprehensive bone building program — one that includes stress reduction and hope.

It’s interesting to note that Traditional Chinese Medicine holds that bone health is determined by the “kidney energy” and that fear is the emotion that disrupts the kidney energetic system. (And even Western medicine links osteoporosis with renal disease because the kidneys play such a central role in vitamin D metabolism, mineral reabsorption, and acid-base balance. (As I have discussed before, when kidneys can’t adequately buffer metabolic acids, calcium from bones is called upon to rescue essential pH homeostasis.) The ancient Chinese wisdom tradition suggests that the kidneys control bone and fear damages the kidneys — and I have found this to be true. All in all, we need less fear and more hope and bone-building solutions.

This isn’t all of course. Look for my post next week giving two more problems with the standard approach to bone health!



Adeva, M. M., and G. Souto. 2011. Diet-induced metabolic acidosis. Clinical Nutrition 30(4):416–421.

Azuma, K., Y. Adachi, H. Hayashi, and K. Y. Kubo. 2015. Chronic psychological stress as a risk factor of osteoporosis. Journal of UOEH 37(4):245–253.

Häussler, B., H. Gothe, D. Göl, G. Glaeske, L. Pientka, and D. Felsenberg. 2007. Epidemiology, treatment and costs of osteoporosis in Germany: The BoneEVA Study. Osteoporosis International 18(1):77–84.

Lu, Nan. 2010. Traditional Chinese medicine: A woman’s guide to a hormone-free menopause. TCMWF Publishing, New York.

Seeman, E., J. P. Devogelaer, R. Lorenc, T. Spector, K. Brixen, A. Balogh, G. Stucki, and J. Y. Reginster. 2008. Strontium ranelate reduces the risk of vertebral fractures in patients with osteopenia. Journal of Bone and Mineral Research 23(3):433–438.

Stone, K. L., D. G. Seeley, L. Y. Lui, J. A. Cauley, K. Ensrud, W. S. Browner, M. C. Nevitt, S. R. Cummings, and Osteoporosis Fractures Research Group. 2003. BMD at multiple sites and risk of fracture of multiple types: Long-term results from the Study of Osteoporotic Fractures. Journal of Bone and Mineral Research 18(11):1947–1954.

Fosamax® is a registered trademark of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.

Prolia® is a registered trademark of Amgen Inc.

What a diagnosis of osteopenia means for you

“Osteo” means bone and “penia” indicates a state of being low in quantity. The term osteopenia refers to a bone density which is somewhat less, but not excessively less, than a “standard” young person (someone in their mid to late 20s) of the same gender. If your bone density measurement indicates that your bone density is between 1.0 and 2.49 standard deviations (SD) below what would be expected in the average young man or woman, then you are said to have a bone density in the osteopenic range. You are said to have osteopenia.

Osteopenia, however, is not a disease or even a true diagnosis. It merely indicates a state of relatively low bone mass — that is, your bone mass is low when compared to the standard. You could have “osteopenia” because you never developed a high peak bone mass in your youth, or because you naturally have bones that are less dense than average (often the case with naturally slender people). It does not have to mean that you are currently losing bone.

On the other hand, some of us with osteopenia are currently undergoing bone loss and on our way to having a higher degree of bone loss, known as osteoporosis.

Recent surveys suggest that a large percentage of individuals in the US have a bone density that’s on the low side, and could be classified as having osteopenia. According to the National Osteoporosis Foundation, some 21.8 million American women and another 11.8 million men have osteopenia.

Osteopenia and fracture risk

While low bone density is one of the risk factors for osteoporotic fracture, having osteopenia does not predict future fracture. In fact various studies document that well over half of those who suffer a low-trauma “osteoporotic” fracture  do not have an osteoporotic bone density. Rather they have “osteopenia,” or even normal bone density.

Statistics on osteopenia and fracture risk

Here are just a few references substantiating the fact that most fractures occur in people with osteopenia.

  • The US Study of Osteoporotic Fractures (SOF) looked at 8,065 women 65 and older. They reported that only 10 to 44% of osteoporotic fractures occurred in those women with an “osteoporotic bone density.”

Stone, K.L. et al. 2003. BMD at multiple sites and risk of fracture of multiple types: Long-term results from the study of osteoporotic fractures. Journal of Bone and Mineral Research, 18(11):1947-1954.

  • According to the National Osteoporosis Risk Assessment (NORA) more than two-thirds of hip fractures occur during the first year of follow-up in women (with an average age of 65 years) who were not deemed to be osteoporotic (they had osteopenia or normal bone mineral density (BMD)

Siris, E.S. et al. 2001. Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA, 286(22):2815-2822.

  • European Data on fBMD and fracture risk found that only 18% of all fractures occurred in women with an “osteoporotic” bone density.

Seeman, E., et al. 2008. Strontium ranelate reduces the risk of vertebral fractures in patients with osteopenia. Journal of Bone and Mineral Research, 23(3):433-438.

Does osteopenia matter?

So what does it matter that your bone density is 1.0 standard deviation (SD) below that of a young person? One way to look at this is to realize that a bone loss of more than 1 SD equals a 10–12% decrease in bone density. Another perspective is that you probably have a bone density that is lower than 84% of the young people of your gender. A final way to look at it is to say that in a young, healthy population, the statistics being used show that about 16% of all young women will have a T-score that is less than -1, and thus have osteopenia.

Remember, if you are not young, you will most likely not have the bone density of a young person. Also know that there is a great deal of controversy regarding how the “ideal” reference bone mineral density is established — different people accept different age groups (some say mid 20s, some late 20s, some early 30s) as the standard for average peak bone density. Currently, each manufacturer of each bone density measurement machine decides on its own “ideal” young person bone density reference range.

Often studies using locally developed reference ranges come up with very different results than those using the manufacturers’ reference range. For example, in the U.S. NHANES III trial, the bone mineral density of a diverse sample of young women was used as the reference range, which cut the prevalence of osteoporosis, as defined by bone mineral density, by more than half. If the DEXA machines’ manufacturers’ reference ranges had been used in this study, the prevalence of osteoporosis of the hip would have been 49%, rather than the 28% they reported. (For more information on the controversy surrounding ideal bone mineral reference ranges, see Gillian Sanson’s book, The Myth of Osteoporosis.)

In short, the “diagnosis” of osteopenia is something that is not cut and dried. If there are other indications that you’re losing bone, then it might be a signal to start paying closer attention to your bone health and consider taking steps to alter your diet and nutritional status. If, on the other hand, there are no signs of bone loss, and you have a healthy diet and lifestyle, being told you’re osteopenic is not a major concern — the fact that you’re “below average” density may be a normal situation for you, and not a sign of a health problem. To learn more on the topic of osteoporosis and bone loss, read our additional articles here:

Worried about osteopenia? A holiday gift from NPR

If you’ve heard the term osteopenia, and especially if you happen to be one of the millions who’ve been “diagnosed” with this “disease”, I urge you to listen to or read NPR’s noteworthy investigative report about Fosamax from December 21, 2009.

I have noted in a prior post that osteopenia is not a disease, just a condition ofrelatively low bone mass — yet it was turned into something to be “diagnosed” and “treated” (with drugs, of course). Since bone loss is common during menopause, this transformation was to the detriment of women worldwide. The graph in the story that shows clearly how sales of Fosamax took off after DEXA scanning became more common (something that was strongly supported by the drug company) really tells the full story of what’s going on.

For all the intrigue, mystery, and manipulation behind the creation of “osteopenia,” tune in for good early winter listening!

Sending each and everyone of you my best wishes for a joyous New Year of health and fulfillment.

– Susan



A look at osteopenia treatment

Osteopenia is the condition in which bone density is somewhat less than a “standard” young person of the same sex. It is not a true diagnosis, nor is it a disease; it is simply a state of relatively low bone mass.

The causes are not always related to bone loss; if you never developed a high peak bone mass during your youth, you could have lifelong osteopenia. Similarly, if you are not a young person, you will not be likely to have the same bone mass as somebody who is young.

Low bone density is one risk factor for osteoporotic fracture; however, having osteopenia doesn’t mean you will have a fracture. In fact, studies suggest that well over half of those who suffer a low-trauma “osteoporotic” fracture do not have an osteoporotic bone density; rather they have “osteopenia” or even normal bone density.  There is much more involved in the equation.

While childhood and adolescence are the best times to build strong bones, there are ways to halt and even somewhat reverse bone loss in adulthood. Contrary to what you might have heard, calcium is not a panacea. There are many other nutrients that play a role in bone health and, in fact, the societies with the highest calcium intakes also have the highest rates of osteoporosis.