Seven out of 10 American women will experience osteopenia or osteoporosis in their lifetime, conditions that weaken bones and increase the risk of fractures. These conditions affect women more than men, especially those going through menopause or postmenopause. Dr. Jocelyn Wittstein, an orthopedic surgeon at Duke University School of Medicine and an expert in menopause and bone health, emphasizes that women should be more aware of their bone health earlier in life rather than waiting until a fracture occurs. "People often think about bone health later in life, after a fracture has already happened," Wittstein said. However, osteopenia—a condition of reduced bone density—can progress to the more severe osteoporosis, which is often called a "silent disease" because it may not cause symptoms until a fracture occurs. Osteopenia and osteoporosis are diagnosed through a Dual-Energy X-ray Absorptiometry (DEXA) scan, which measures bone mineral density using a "T-score" that compares an individual's bone density to that of a healthy 30-year-old. A normal T-score is between 0 and -1, while a score between -1 and -2.5 indicates osteopenia, and a score below -2.5 indicates osteoporosis. Wittstein notes that many women wait until they are 65 to get a DEXA scan, but she believes the ideal time is during the menopause transition, around 50 or 51 years old. Early detection is crucial in slowing the progression of bone density loss and preventing it from worsening into osteoporosis. To protect bone health, Wittstein recommends incorporating strength training and impact exercises into daily routines. These types of exercises signal the body to build stronger bone tissue, improving balance and reducing the risk of falls and fractures. She also highlights the importance of a balanced diet rich in micronutrients like calcium, vitamin D, vitamin K, and magnesium, which all work together to support bone health. For example, vitamin D helps the body absorb calcium, while vitamin K directs calcium to the bones for mineralization. Wittstein suggests daily intake of 600-800 units of vitamin D, 1,000 milligrams of calcium, and 300-400 milligrams of magnesium, but always with the guidance of a healthcare provider. Menopausal hormone therapy (HRT) may also play a role in preserving bone density, as estrogen helps regulate bone breakdown. However, HRT is not suitable for all women, and it should be discussed with a doctor. Wittstein notes that HRT is approved by the FDA for bone protection, in addition to managing menopausal symptoms like hot flashes. While there is no cure for bone diseases like osteopenia or osteoporosis, taking proactive steps such as exercise, proper nutrition, and considering HRT can help slow their progression. Wittstein encourages women to be informed and proactive about their health, as early action can make a significant difference in maintaining strong bones and quality of life.