Bone Health — Prevention & Protection

Who should have a bone density scan (DXA)?

DXA should be performed for:

• Amenorrhea for more than 6 months and under 45
• Hyperthyroidism or hyperparathyroidism
• Malabsorption conditions (including celiac disease)
• Chronic kidney or liver disease
• Rheumatoid arthritis
• Long-term glucocorticoid therapy (e.g. prednisolone ≥7.5 mg/day for 3+ months)
• Aromatase inhibitor therapy for hormone-sensitive breast cancer

DXA also recommended when:

• Low or normal body weight (BMI under 20–22)
• Limited mobility
• Current smoker
• More than 2 standard drinks per day
• Diabetes, malnutrition, or other bone-affecting conditions

Understanding your T-score

Why −1.8 is a key threshold

Research from the NORA study found that a T-score of −1.8 or below was associated with a meaningful increase in short-term fracture risk in postmenopausal women aged 50+. One-third of all fractures and one-fifth of hip fractures occurred in women aged 50–64.

MHT and bone protection

The Women’s Health Initiative study provides compelling evidence: MHT reduced vertebral and non-vertebral fractures by 34% in a large, diverse group of women, regardless of baseline bone density, BMI, smoking status, history of falls, family history, or calcium intake.

Calcium, vitamin D & lifestyle

Nutrition for bones:

• Calcium: 1,000–1,200 mg/day through diet
• Vitamin D: levels above 50 nmol/L; 1,000–2,000 IU/day supplementation commonly recommended
• Magnesium: cofactor for calcium — nuts, seeds, legumes, dark chocolate
• Adequate protein for muscle and bone health
• Vegans: monitor zinc, calcium, vitamin D, and B12

Activity & habits:

• Weight-bearing exercise and balance training reduce both bone loss and fall risk
• Limit alcohol to fewer than 2 standard drinks per day
• Smoking cessation is essential — smoking significantly accelerates bone loss