Summary:
- Women naturally have lower peak bone mass.
- Estrogen loss accelerates bone density decline.
- Genetics and family history influence risk.
- Health conditions and certain medications matter.
- Lifestyle factors affect bone strength.
- Osteopenia often shows no obvious symptoms.
Why Women Are at Higher Risk for Osteopenia
Let’s start with something most women are never told clearly: bone loss doesn’t “suddenly happen when you’re old.” For many women, it begins quietly in their 40s and 50s — sometimes earlier — and it can keep progressing unless we step in and do something about it.
That early stage of bone loss is called osteopenia . Osteopenia means your bone density is lower than what we consider normal for a healthy adult, but not low enough to be called osteoporosis. Think of it as a warning light. It’s not an emergency by itself, but it’s telling you that your bones deserve attention now, not later. In this blog, we’re going to talk about why women are more likely to develop osteopenia, what drives that risk, and what you can realistically do about it.
This information reflects guidance from major U.S. women’s health and bone health institutions including the American College of Obstetricians and Gynecologists (ACOG), the Cleveland Clinic, and academic medical centers like the University of Chicago Medicine and Northwestern Medicine. These organizations all highlight that bone health in midlife women is not cosmetic — it’s safety, independence, and quality of life.
1. Women start with less “bone bank” to spend
One of the biggest reasons women are more vulnerable to osteopenia has nothing to do with something they “did wrong.” It’s biology.
On average, women naturally have:
Thinner bones
Smaller frame size
Lower peak bone mass compared to men
Peak bone mass is basically your personal “bone savings account.” You build most of it in your teens and 20s. Men typically start adulthood with more in the account. Women start with less. So when bone loss begins later in life, women have less reserve to lose before they cross into osteopenia and eventually osteoporosis. This is well documented in U.S. population data on bone mineral density differences between sexes.
That means two women in their 50s can look “healthy” on the outside, feel fine, and still be at very different levels of fracture risk depending on what their bone mass looked like at 25. You can feel strong and independent and still have low bone density. That’s why screening matters (more on that later).
2. Estrogen is protective — and menopause takes it away quickly
If you’ve ever heard someone say, “My bones went downhill after menopause,” that’s not an exaggeration.
Estrogen is one of the body’s natural protectors of bone. It helps keep the balance between bone-building cells and bone-breaking-down cells. When estrogen drops sharply around menopause, that balance shifts in favor of bone breakdown.
Here’s the part most women are never warned about:
In the first 5–7 years after menopause, women can lose up to 20% of their bone density. That’s a huge, rapid loss in a short window.
So, if you picture bone health like a slow drip over time — that’s not really accurate. It’s more like a cliff. You’re fairly steady through your 30s and early 40s, then menopause hits, estrogen falls, and bone density can drop quickly. This is why osteopenia often shows up in the 50s, and why postmenopausal women are so strongly represented in osteopenia and osteoporosis statistics in the U.S. According to U.S. surveillance data on older adults, more than half of postmenopausal women have low bone mass (osteopenia), and women make up roughly 80% of osteoporosis cases overall.
To put that into real life terms: about one in two women will experience a fracture related to osteoporosis in her lifetime. That’s not just hip fractures in very old age. We also see spine compression fractures that can reduce height, change posture, and cause chronic back pain. These are quality-of-life fractures.
3. Osteopenia isn’t just “a bone problem.” It’s a hormone, genetics, and lifestyle story.
When we talk about osteopenia risk factors in women, there are several layers.
Hormonal factors
Early menopause (naturally occurring before age 45)
Surgical menopause (ovaries removed)
These situations mean less lifetime estrogen exposure. Less estrogen = faster bone loss. This is a known risk factor identified by organizations such as ACOG and major women’s health programs.
Genetics and family history
Bone density has a strong hereditary component. Some estimates suggest that 60–80% of your peak bone mass may be genetically influenced. In other words, if your mother or grandmother had osteoporosis, broke a hip, or “shrunk” noticeably with age, that’s meaningful information for you.
Underlying health conditions and medications
Certain conditions raise the risk of bone loss, including:
Overactive thyroid
Autoimmune inflammatory diseases
Long-term corticosteroid use (for asthma, autoimmune conditions, etc.)
Certain gastrointestinal conditions that affect nutrient absorption
These aren’t rare edge cases. They are everyday realities for a lot of women in midlife. U.S. guidance on osteoporosis prevention routinely calls out chronic steroid use as a red flag for earlier or more frequent bone density testing.
4. Lifestyle matters — and in some cases, lifestyle is fixable
There are also modifiable osteopenia causes. These are the areas where you actually can take action:
Smoking and heavy alcohol use
Both are linked to faster bone loss over time. Smoking in particular interferes with bone-building cells and is repeatedly cited in U.S. bone health guidelines as a risk factor for both osteopenia and progression to osteoporosis.
Low calcium and vitamin D intake
Your bones are constantly remodeling. They need raw materials. If you aren’t consistently getting enough calcium and vitamin D, your body will “borrow” calcium from bone to keep blood levels stable. Over time, that weakens bone. Northwestern and Cleveland Clinic both emphasize adequate calcium and vitamin D as first-line prevention.
Very low body weight or chronic under-fueling
Being significantly underweight, crash dieting, disordered eating, or the “female athlete triad” (low energy intake, menstrual irregularity, and low bone density) all increase risk. This is especially important for younger women and athletes. Sometimes we see women in their 20s and 30s already showing early bone loss patterns because their body simply hasn’t had the calories, protein, and hormones it needs to maintain bone strength.
Sedentary lifestyle
Bones respond to load. Weight-bearing exercise (walking, light strength training, resistance work) signals bones to stay dense. Long periods of sitting, not moving, or never challenging your muscles and bones makes it easier for bone mass to slide.
The encouraging part: these are areas where coaching, nutrition changes, and smart movement plans can help stabilize or slow loss.
5. Osteopenia is called “silent” for a reason — you usually don’t feel it
Most women with osteopenia feel completely normal. No pain, no obvious symptoms. That’s why screening is so important.
In the U.S., the standard test is a DXA (or DEXA) scan , which is a low-radiation imaging study that measures bone mineral density, usually at the hip and spine. It’s painless and quick. Major U.S. guidelines (including those followed by women’s health and internal medicine groups) recommend routine bone density screening for:
All women age 65 and older
Younger postmenopausal women who have risk factors (for example: family history of osteoporosis, low body weight, history of fractures, smoking, or long-term steroid use)
We also use tools like the FRAX score , which estimates your 10-year risk of a major fracture. FRAX helps us decide how aggressive to be with treatment. If your FRAX score shows that your fracture risk is already significant, we may start medical therapy even if you’re technically in the “osteopenia” range instead of full osteoporosis. This is common, and it’s based on fracture risk, not just the number on the scan.
6. What you can do today to protect your bones
Here is what I tell my patients in Chicago when we sit down and talk about bone health:
Know your numbers.
If you’re over 65, or younger but postmenopausal with risk factors, ask about a DXA scan. Don’t wait for your first fracture to learn you’ve had osteopenia for years.
Look honestly at calcium and vitamin D.
We will review diet first (dairy, leafy greens, fortified foods), then talk about supplements if needed. This is not just “take a pill.” It’s about making sure your bones are getting what they need, daily.
Do some form of resistance or weight-bearing movement.
You do not have to become a gym person. Walking with light hand weights, using resistance bands at home, climbing stairs, bodyweight squats — these count. The goal is to give your bones a healthy amount of load.
Avoid or limit bone drains.
That means smoking cessation support, moderating alcohol, and addressing chronic under-eating or very low BMI. These are hard topics, but they are bone topics.
Manage the bigger picture.
If you have thyroid disease, inflammatory conditions, or you’re on long-term steroids, your bone health absolutely needs to be part of that conversation. You deserve coordinated care.
The bottom line
Women are not “fragile by default.” But women are biologically set up to lose bone faster, especially around menopause, and we live longer — which means we spend more years at risk. The combination of naturally smaller bones, estrogen loss, genetics, lifestyle pressures, and certain medical conditions puts women at higher risk for osteopenia, and eventually osteoporosis, than men.
The most important message is this: osteopenia is not the end of the story. It is the beginning of the plan.
With early screening, realistic nutrition support, smart movement, and, when appropriate, medical treatment, we can slow bone loss, reduce fracture risk, and help you stay strong, independent, and active for decades to come.
Your bones are part of your long-term health, not an afterthought.
If you’re concerned about bone density — especially if you’re postmenopausal, have a family history of osteoporosis, or have noticed a decrease in height or posture — schedule a bone health evaluation with Dr. Merchant at drshehrebanu.com. We will talk about your personal risk, review whether a DXA scan makes sense now, and build a plan that fits your life