I lay on the DEXA table last week with my knees propped on a foam block, and I thought about every year I starved myself from 15 to my 30s. The arm of the DEXA machine passed over me like the slowest incoming tide, clocking the ways that I have abused and abandoned my poor body. Ten minutes of lying still while a machine read what decades of hunger, restriction, bulimia, running, pregnancy, nursing, more running, and grief had left inside me.
Your bones remember everything, and being female, Caucasian, at a current weight of 126 pounds, with a history of disordered eating, and postmenopausal, I now have five risk factors for osteoporosis. For me, the eating disorder may be the strongest risk factor among the five.
You reach peak bone mass earlier than you may realize. Newer data shows that peak bone mass occurs at your hip at 18, and at the lumbar spine at 20. Those were the years that I was face down in food restriction. I’ve been in recovery from anorexia and bulimia for 19 years, but recovery doesn’t change what happened to my skeleton at that vulnerable time.
Even with four risk factors for osteoporosis, no primary care doctor has ever ordered a bone density scan for me or asked about my history with food. I was worried about the answer, and as I sat there on the table last week, I was worried I’d waited too long.
I’ll tell you what the DEXA showed at the end.
We were taught to think of the skeleton as scaffolding, a coat rack for the parts of us that matter like the brain, heart, and uterus. But your bones are much more alive than that framing suggests: it dissolves and rebuilds itself every day, makes your blood in its marrow, and holds nearly all the calcium your heart needs to beat [1].
Your skeleton is an archive of your lifestyle and habits from the past few decades. It remembers the diet you started at 15, the year (or years) you nursed a baby, the winter you couldn’t eat due to grief, like during my recent divorce. It remembers every heavy thing you ever lifted, too. That’s important, because the heavy weight lifting that I began when I was 14 and continued through college, medical school, and OB/GYN residency may have saved me from the fate of osteopenia or osteoporosis.
Clarissa Pinkola Estés tells the story of La Loba, an old woman in the desert who gathers the bones of wolves. When she has a whole skeleton, she sits by the fire and sings over it until it grows flesh and fur and runs off into the night [2]. I’ve always read that story as a teaching about women. What’s essential in us lives in the bones. It survives the drought, and self abandonment. And it can be sung back to life.
Our language knows this: we feel things in our bones, we tell the bare-bones truth. Women are told to grow a spine at work and soften it at home, to stand up straight and take up less room, impossibly, and all at once.
You built nearly all the bone you’ll ever have by about age 20 [3]. Those are the years a girl’s skeleton makes the deposits that will carry her to 90 or 100 or older. They’re also the years the prevailing culture tells her to shrink.
My generation called it dieting. We ran it on rice cakes and Tab (remember Tab? I would starve all day and drink only Tab), and we cheered for each other when our hip bones showed. Restriction in those years costs bone that may never fully come back. Most young women with anorexia have low bone mass [4]. Many of us are reading the results now, decades later, on our DEXA reports.
For a while we told ourselves the culture had changed. We raised our daughters on body positivity and every size welcome. We overcame diet culture. Then the GLP-1 injections arrived, and thin came back faster than any of us expected. I especially see it in college women.
Between 2020 and 2023, the number of people ages 12 to 25 dispensed a GLP-1 medication rose nearly 600 percent [5]. On some campuses, these drugs have become a kind of social currency, a shortcut to the body that sorority rush seems to demand [6]. Without enough protein and strength training, a large share of the weight lost can come from muscle [7]. And muscle is what pulls on bone and tells it to stay strong.
I’m worried about our young women’s bones and muscle. I believe we’ll see osteopenia and osteoporosis in women in their 30s and 40s within the next 5 to 10 years, at rates we haven’t seen before. Disordered eating used to take years of white-knuckled restriction. Now it can arrive in a pen, sometimes after a brief telehealth visit, and nobody asks a 19-year-old about her period, her protein, or her bones.
GLP-1s are important medicines, and many young people who take them have obesity, diabetes, or other real medical need. My worry is the girl at a normal weight, spending her peak bone years in a calorie deficit nobody is measuring, chasing a body her grandmother chased with cigarettes.
I see osteopenia and osteoporosis in so many of my patients, and I’m seeing it younger women than I used to. Women who look strong are getting diagnosed with severe osteoporosis in their 40s. I never saw this 25 years ago. Women who run marathons, run companies, and run households. They come to me for sleep or desire or brain fog, and their DEXA tells a story they had no idea was occurring.
About one in three women in Western countries will break a bone from osteoporosis after age 50 [8]. Bone loss makes no sound. It happens silently, in the background, with no grand announcements. Often the first sign is a fracture.
Here are the risk factors according to the American College of Obstetricians and Gynecologists in addition to what I’ve mentioned (female sex, race, menopause, and low weight). Low bone mineral density and a prior fragility fracture are the strongest predictors of future fracture.
Increasing ageParental history of hip or spine fractureSmoking****Excessive alcohol(more than 3 drinks/day)**Conditions linked to secondary osteoporosis:HIV/AIDS, type 1 and type 2 diabetes, gastric bypass, hyperparathyroidism, hypocalcemia,premature menopauseor primary ovarian insufficiency, renal impairment, rheumatoid arthritis, Turner syndrome, and vitamin D deficiencyMedications:**glucocorticoids, antiepileptics (phenytoin, carbamazepine, primidone, phenobarbital), antiretrovirals, aromatase inhibitors, chemotherapy, DMPA, GnRH agonists and antagonists, and heparin
Here’s why I was afraid on that table. I had an eating disorder from age 15 to 39. Those were my peak bone years, and I spent them restricting. I’m now 59 and postmenopausal, I weigh 125 to 127 pounds, which counts as low body weight for bone. I’m white, and white women have some of the highest rates of osteoporosis [9]. On paper, I’m the woman I’d send for a DEXA as a matter of routine care.
My results came back last week, and I was a little shocked. Every site came back in the normal range.
Zero is the average bone density of a young woman at her peak. Below −1.0 is osteopenia. Below −2.5 is osteoporosis. Compared with women my age, my bones sit near the top.
What do I credit? Lifting heavy. Running, for decades. I gave it up in my early 50s and picked it back up again two years ago. Keeping my vitamin D up. Eating rich sources of calcium (today I made gluten-free Mac and cheese with gluten free pasta and cottage cheese, served with broccoli, a total of about 30 grams of protein and 350 mg of calcium. Let me know if you want the recipe in the comments — it was so good!) And my rebounder, a mini trampoline I still run and jump on almost every day after buying it 20 years ago to run on).
I can’t prove which of these mattered most. Bone responds to impact and load, and I’ve given mine both, nearly every day, for years. We need to nurture ourselves in this way. It’s self stewardship: treating your body as something entrusted to you, not something to shrink. Every landing when I jump or run sends a small message down through my heels and hips and spine: stay.
And for women who can’t jump, there’s something worth knowing about. The FDA has cleared a wearable belt that sends a gentle vibration into the hips and spine, the first prescription device for women with osteopenia [10]. I’m watching it closely and will be writing about it next. Let me know if you want to hear more. It’s like a vibration plate in a belt!
La Loba doesn’t find whole skeletons. She gathers them piece by piece across the desert, and then she sings. I think that’s the work of a woman’s middle years. You gather what’s left after the diets, the babies, and the decades of giving. Then you load your bones, feed them, and keep showing up for them until they hold you again.
1. Ask for a DEXA before 65. Tell your doctor that you have a risk factor.
2. Load your bones every day. Lift something heavy, jump, take the stairs two at a time.
3. Talk to the young women in your life about bone, muscle, and protein before it’s too late and they have to chase bone through a prescription.
Your bones were there before you had the words to appreciate them, and they’ll be the last of you to leave. Treat them like the precious core of you that they are.
**Please tell me in the comments: **
What has your skeleton carried for you, and what does it need from you now?
How might you create a practice of self stewardship with your bones?
Please share this post with a woman you know and love, who needs to know the latest news about the rising epidemic of low bone density.
xo, Dr. Sara
Notes
[1] Clarke B. “Normal Bone Anatomy and Physiology.” Clinical Journal of the American Society of Nephrology 3, suppl. 3 (2008): S131–39.
[2] Estés CP. Women Who Run with the Wolves: Myths and Stories of the Wild Woman Archetype. New York: Ballantine Books, 1992.
[3] Xue S, et al. “Age at Attainment of Peak Bone Mineral Density and Its Associated Factors: The National Health and Nutrition Examination Survey 2005–2014.” Bone 131 (2020): 115163.
[4] American College of Obstetricians and Gynecologists. “Committee Opinion No. 740: Gynecologic Care for Adolescents and Young Women With Eating Disorders.” Obstetrics & Gynecology 131, no. 6 (2018): e205–13.
[5] Lee JM, et al. “Dispensing of Glucagon-Like Peptide-1 Receptor Agonists to Adolescents and Young Adults, 2020–2023.” JAMA 331, no. 23 (2024): 2041–43.
[6] Pratt E. “When GLP-1s Become a Social Currency: The Prescription Pressure Spreading Across Campus.” MDLinx, October 26, 2026.
[7] Chun E, et al. “Weight Loss and Body Composition after Compounded Semaglutide Treatment in a Real World Setting.” Diabetes, Obesity and Metabolism 27, no. 3 (2025): 1536–43.
[8] Lorentzon M, et al. “Osteoporosis and Fractures in Women: The Burden of Disease.” Climacteric 25, no. 1 (2022): 4–10.
[9] Morin SN, et al. “Osteoporosis: A Review.” JAMA 334, no. 10 (2025): 894–907.
[10] “FDA Clears Wearable Vibration Belt for Postmenopausal Women with Osteopenia.” Healio, January 18, 2024.
