Osteoporosis: What Every Woman Over 35 Needs to Know

When you’re in your 30s or 40s you’re probably not thinking much about your bone health — that’s just for older adults to worry about, right? Think again. While osteoporosis often affects people after menopause, the foundation for strong bones is built decades earlier. In fact, women reach their peak bone mass in their 20s and 30s.

But here's the good news: It's never too late to strengthen your bones. By focusing on healthy habits and exercises now, you can significantly reduce your risk of fractures later in life. Approximately one in two women over 50 will experience a fracture due to osteoporosis. However, with the right strategies, you can protect your bone health. 

What is osteoporosis?

Osteoporosis is a bone disease where bones lose density and strength, becoming porous and fragile. This happens when your body either loses too much bone, produces too little, or both. As a result, bones are more likely to break during things like a fall. As they become more fragile, your bones are at risk for breaking even because of something as minor as a sneeze. 

It’s often called a "silent disease" because you may not even notice symptoms until a fracture occurs.

What are the symptoms of osteoporosis?

Since it’s silent, osteoporosis often progresses without obvious symptoms — at first. However, there are a few warning signs that you should be aware of to detect bone loss early and take preventive action. Recognizing these symptoms can help reduce your risk of fractures and ensure timely treatment.

1. Loss of height and postural changes

With osteoporosis, you may lose height over time due to compression fractures in your spine. These fractures cause your vertebrae to collapse, shortening your spine and leading to a gradual decrease in height. In some cases, this can result in a rounded or hunched posture (kyphosis), often accompanied by back pain and poor balance, which increases the risk of falls.

2. Increased risk of fractures

One of the most concerning signs of osteoporosis is an increased risk of fragility fractures, which occur from minor falls or even everyday activities like bending, lifting, or sneezing. These fractures commonly affect your wrist, hip, and spine. In people with normal bone density, these types of fractures are unlikely, making them a clear indicator of weakened bones in individuals with osteoporosis.

3. Unexplained back pain

If you have osteoporosis, you may have unexplained back pain caused by tiny, undiagnosed fractures in the vertebrae. These micro-fractures weaken your spine and can result in chronic pain or discomfort that worsens over time.

What causes osteoporosis?

Osteoporosis is influenced by both modifiable (controllable) and non-modifiable (uncontrollable) factors. Folks assigned female at birth (AFAB) are at a higher risk because of hormonal changes, genetic factors, and lifestyle choices that affect bone health over time. Understanding these risk factors can help you take proactive steps to maintain strong bones and prevent fractures as you age.

Modifiable risk factors

The good news? Many factors contributing to osteoporosis can be controlled through lifestyle changes. Making healthier choices can significantly impact your bone health and reduce your risk:

• Diet: Low calcium and vitamin D intake weakens bones, reducing their density.
• Physical activity: Lack of weight-bearing or resistance exercise leads to bone loss.
• Smoking: Tobacco use decreases bone mass and accelerates bone loss.
• Alcohol consumption: Excessive alcohol use disrupts calcium absorption and affects bone formation.
• Medications: Long-term use of corticosteroids and certain other medications can weaken bones.

Focusing on these factors early — especially during younger years when peak bone mass is developing — can build a strong foundation and lower the risk of osteoporosis later in life.

Non-modifiable risk factors

While some aspects of osteoporosis risk can’t be changed, being aware of them can help you take preventive measures:

• Age: Bone density naturally decreases as you age, especially after midlife.
• Sex: Women are more likely to develop osteoporosis due to hormonal changes.
• Menopause: Estrogen plays a vital role in maintaining bone mass. After menopause, estrogen levels plummet, causing a rapid increase in bone loss.
• Family history: A family history of osteoporosis or fractures raises your likelihood of developing the condition.
• Body frame: Individuals with smaller, thinner frames have less bone mass to draw from as they age, increasing their vulnerability.

Recognizing these uncontrollable factors allows you to be more vigilant and take preventive actions, such as focusing on diet, exercise, and regular screenings.

Why is osteoporosis more common in women?

Osteoporosis affects those AFAB disproportionately compared to folks assigned male at birth (AMAB). Most of this increased risk boils down to hormonal changes and biological differences.

Hormonal impact of menopause

Estrogen, the hormone responsible for protecting bones, decreases dramatically during menopause. This drop leads to faster bone resorption (the process of breaking down bone tissue) and slower bone formation, resulting in a rapid decline in bone density.

According to the Bone Health and Osteoporosis Foundation (BHOF), some folks can lose up to 20% of their bone mass in the 5 to 7 years following menopause, significantly increasing their risk of fractures.

Genetics and bone structure

Folks with a family history of osteoporosis or fractures have a higher genetic predisposition to develop the condition. And people AFAB with smaller, thinner frames start with a lower bone mass, making them more susceptible to bone loss over time.

How common is osteoporosis?

Osteoporosis is a global public health concern, especially if you’re over 50. Here's a snapshot of the staggering statistics:

• Worldwide, 1 in 3 people AFAB over 50 will experience osteoporotic fractures (compared to 1 in 5 men).
• The most common fracture sites include the hip, spine, and wrist.
• In the United States, approximately 19.6% of folks AFAB aged 50 and over were diagnosed with osteoporosis between 2017 and 2018.
• Osteoporosis prevalence increases with age — 27.1% of folks AFAB 65 years and older are affected by the condition.

These numbers highlight the urgency of early intervention and consistent bone health management, especially for those entering their 30s and beyond. Investing in bone health early on can significantly reduce the risk of osteoporosis-related fractures later in life.

Why early detection matters

Because osteoporosis often goes unnoticed until a fracture occurs, regular bone density screenings are so important for early diagnosis and prevention. If you’re over 50 or have multiple risk factors, prioritize routine screenings to maintain bone health and prevent severe fractures. 

Taking proactive steps — such as improving nutrition, engaging in weight-bearing exercises, and seeking medical evaluation — can significantly reduce the risk of osteoporosis-related complications.

What is a DEXA scan?

A DEXA scan (Dual-Energy X-ray Absorptiometry) is a specialized test used to measure bone mineral density (BMD) and assess the strength of bones. This painless, low-dose X-ray scan evaluates bone mass, typically at your hips and spine — the most common sites for osteoporosis-related fractures.

Unlike regular X-rays, a DEXA scan can detect small changes in bone density, making it the gold standard for diagnosing osteoporosis and predicting fracture risk. Identifying bone loss early through a DEXA scan allows for timely intervention to prevent fractures and preserve bone health.

When should I get a DEXA scan?

Most people should have their first DEXA scan at age 65 when the risk of osteoporosis increases. If you’re under 65, you should consider a DEXA scan if you have:

• A family history of osteoporosis or fractures.
• A history of fragility fractures after age 50.
• Low body weight or a small frame.
• Long-term use of corticosteroids or other medications that weaken bones.
• Smoking or excessive alcohol use.

Protecting your bones starts now (with physical therapy at Origin)

Osteoporosis may be a “silent disease,” but that doesn’t mean it should be ignored. The good news is that you can take proactive steps to strengthen your bones and reduce your risk of fractures. Remember, bone health starts early — the habits you build now will impact your risk of osteoporosis later. Prioritize weight-bearing exercises and proper nutrition to help keep your bones strong. And get regular bone density screenings, like a DEXA scan, to help you understand more about your bone health now.

Not sure where to start? Take charge of your musculoskeletal health today by booking an evaluation with one of the physical therapists at Origin Physical therapy. They’ll work with you to learn all you need to know about your bone health and use evidence-based strategies, and effective exercises to help reduce your risk of osteoporosis-related fractures. Your bones will thank you later!