In Part 1, we looked at the fear of getting bulky. In Part 2, the habit of stretching an achy back. This week, it’s perhaps the most deeply held myth of all, certainly among women: that thinner means healthier.

Like many women, I have spent years yo-yo dieting on one weight-loss regimen or another. As a journalist, I used to write for diet magazines like Weight Watchers and Slimming World, and I’ve followed every diet going myself.

Invariably, as time wore on, my weight would creep back up. I’d blame myself, eat more for a while, then try another diet.

My goal in life was to be as thin as possible. I only managed it for short bursts, but I was on never ending diets. Plus, I had an extremely unhealthy relationship with food. That’s a story for another article.

This one is about how the belief that ‘being thinner is always healthier’ can cost women. Specifically, their bone health.

I ended up with osteopenia, which is low bone density. There’s good evidence that repeated dieting and under-eating can take a toll on bone. I believe years of crash diets and poor nutrition may have played a part in my bone loss, among other factors.

Let me be clear, though: I’m not saying weight doesn’t matter, because it does. Actually, let’s name it: excess fat, rather than ‘weight’.

A healthy ‘weight’ is good for your heart, your joints and your bones. But ‘healthy’ and ‘as thin as possible’ are not the same thing.

Why thin seems like healthy

It’s easy to see why we treat ‘thin’ and ‘healthy’ as the same. Decades of social conditioning and diet culture has convinced us that it must be so.

When we lose weight, friends tell us how great we look because we shed a few pounds. We may get “Oooh you look sooo trim” but we will never get “oooh, you look like you have strong bones.”

Newspapers and magazines report on the weight loss and weight gain stories of celebrities (usually women) as if it actually matters. Social media influencers share their ‘thinspiration’, posting filtered bikini shots while sipping a green smoothie. From the outside, it looks like a healthy lifestyle.

The fitness industry doesn’t help, either. Much of it relies on people’s insecurities about weight for business, so you see programmes galore built on extreme weight loss regimes promoted as a health ideal. They advertise ‘12 week transformations’ with before and after pictures of successful clients.

What they don’t show is how many people regain the weight, or more, afterwards. The evidence is fairly established. On average, more than half of lost weight is regained within two years, and more than 80% by five years (Hall & Kahan, 2018).

There are many reasons for this, but what matters for this article is that people often end up in perpetual cycles of losing and gaining weight. Like being too thin, this yo-yo cycle is also not healthy.

Shall we look at the evidence?

I want to be clear that this isn’t about thin-shaming, nor, of course, is it about fat-shaming. I’m just here to share the facts.

One of the biggest health risks for older women is osteoporosis. One in two women over 50 will break a bone because of it (Bone Health & Osteoporosis Foundation). And among older women, it’s the thinnest who are most at risk, compared with their peers of a normal weight.

According to Harvey et al. (2025), underweight women had more than twice the risk of hip fracture compared with women of a healthy weight. Part of that was down to thinner bones.

But even when the researchers compared women with the same bone density, the underweight women were still around 70% more likely to break a hip. Being underweight was also linked to higher death rates.

A large study of almost 60,000 people found that a BMI of 20 carried almost twice the risk of hip fracture of a BMI of 25 (De Laet et al., 2005). The risk rose most sharply at the low end of the BMI scale.

Does this mean people with obesity have stronger bones? They tend to have higher bone density, partly because of the extra load their skeleton carries. But obesity does not protect against fracture. Rather, it changes where fractures happen.

Compston et al. (2011) found that women with obesity had more ankle and upper leg fractures, though fewer wrist fractures.

Another interesting piece of the puzzle comes from a study of heart health. Srikanthan et al. (2021) found that women with high muscle mass and higher body fat had a 42% lower risk of dying from heart disease than women with low muscle and low fat.

What this research points to is the protective power of muscle, which is much harder to build when you’re focused on staying thin. The aim is a healthy weight (not too thin, not carrying too much body fat) and then to train for strength and muscle.

So what is a healthy weight?

We all need some fat. It does several jobs, and for women that includes helping to regulate hormones. What matters is how much fat we carry compared with lean tissue, not how big or small the number on the scales is.

That’s especially true once we start strength training, because the number on the scales may not change much, or may even go up, while body fat comes down. One of my former PT clients dropped two dress sizes without the scales budging. The scales can be very deceptive!

Most of us don’t have access to a DEXA scan, which can measure fat and lean mass fairly accurately. Therefore, a good, accessible indicator is your waist.

NICE advises adults with a BMI under 35 to keep their waist to less than half their height. So if you’re 5ft 4in (64 inches), aim for a waist under 32 inches. Measure halfway between your lowest rib and the top of your hip bone.

The NHS has a handy calculator tool.

Most health and fitness professionals now recognise BMI (body mass index) as a crude tool. It can’t account for body composition, and I’ve known people with very muscular, lean physiques who still register a high BMI, because muscle is denser than fat.

So take BMI with a pinch of salt, and check your waist.

Lose weight slowly to lose weight safely

The diet and fitness industries never say “Lose weight responsibly” the way the alcohol industry has to say “Please drink responsibly.”

Helping people manage their weight, where needed, is part of a PT’s remit. But because everyone loves a quick fix, many PTs are under pressure to get fast results with clients, and that isn’t always the best option.

The Royal Osteoporosis Society says that “A restricted calorie diet may reduce bone strength.” It adds that “If you lose weight rapidly, up to a third of the weight you lose will be lean mass.”

Lean mass is largely muscle. So along with the fat we’re so keen to lose, rapid weight loss can strip away our much-needed metabolic engine: our muscle.

A meta-analysis of diet trials found that diet-induced weight loss reduced hip bone density over 6 to 24 months, although the spine wasn’t significantly affected (Zibellini et al., 2015). The authors called the loss small compared with the metabolic benefits for people with obesity.

The arrival of GLP-1 weight-loss injections muddies the waters further. I’m not against them, but the weight loss they bring can be very fast.

A 2024 trial of people on a weight-loss injection found that those who exercised alongside the drug did better for bone than those on the drug alone (Jensen et al., 2024). That means anyone using them should combine their treatment with exercise, particularly strength training, to protect muscle and bone.

The message here is not “Don’t lose weight.” It’s “if you need to lose weight, do it while protecting your bones and muscles”.

Strong, not small

So what does protect our muscles and bones? The answer is given through this whole series: strength training.

In one trial, older adults with obesity lost around 9% of their body weight over six months. Those who did only cardio lost 2.6% of their hip bone density. Those who lifted weights lost just 0.7% (Armamento-Villareal et al., 2020). Same weight loss, but very different result for their bones.

For women, timing matters too. Bone loss speeds up from about a year before the final menstrual period which marks menopause, at roughly 2% a year for about three years (Greendale et al., 2012). Crash dieting in midlife piles more loss on top, at the worst possible time.

So if you’re losing weight, or thinking about it:

• Do total body strength training two to three times a week.

• Aim for slow, steady loss rather than rapid drops.

• Eat enough, with 20-30g of protein at every meal.

• Keep walking for your heart and mood, but don’t rely on it for your bones.

• On weight-loss injections? Ask your doctor about your bone health.

• For anything specific about how much to eat, supplements or medication, speak to your doctor or a registered dietitian.

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Quick healthy weight check:

1. Check your BMI

Use the NHS BMI calculator. Remember that it’s a rough guide, because it can’t tell muscle from fat, but it can tell you if you’re underweight (a BMI under 18.5).

2. Check your waist

Use the NHS waist-to-height calculator. Aim to keep your waist to less than half your height. This tells you if you’re carrying too much fat around your middle, which BMI can miss.

3. Why you need both

The NHS doesn’t indicate what a waist that would be too small is, the waist-to-height guidance only tells you when your waist is too big. So a small waist on its own doesn’t prove you’re healthy, and a “healthy” BMI doesn’t rule out excess fat around your middle.

Use BMI to check you’re not underweight, and your waist to check you’re not carrying too much around your middle.

Putting the two together:

The NHS tools aren’t suitable for everyone, so check the guidance on each page first. For example, the waist calculator isn’t for use if you’re pregnant, have a BMI over 35, or have, or think you may have, an eating disorder.

If any of these sound familiar, or food and weight have been a struggle for you, your GP is a good first step.

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References

Armamento-Villareal R, Aguirre L, Waters DL, et al. Effect of aerobic or resistance exercise, or both, on bone mineral density and bone metabolism in obese older adults while dieting: a randomized controlled trial. Journal of Bone and Mineral Research. 2020;35(3):430-439. doi:10.1002/jbmr.3905

Compston JE, Watts NB, Chapurlat R, et al. Obesity is not protective against fracture in postmenopausal women: GLOW. American Journal of Medicine. 2011;124(11):1043-1050. doi:10.1016/j.amjmed.2011.06.013

De Laet C, Kanis JA, Odén A, et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporosis International. 2005;16(11):1330-1338. doi:10.1007/s00198-005-1863-y

Greendale GA, Sowers M, Han W, et al. Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: results from the Study of Women’s Health Across the Nation (SWAN). Journal of Bone and Mineral Research. 2012;27(1):111-118.

Hall KD, Kahan S. Maintenance of lost weight and long-term management of obesity. Medical Clinics of North America. 2018;102(1):183-197. doi:10.1016/j.mcna.2017.08.012

Harvey NC, Johansson H, McCloskey EV, et al. Body mass index and subsequent fracture risk: a meta-analysis to update FRAX. Journal of Bone and Mineral Research. 2025;40(10):1144-1155. doi:10.1093/jbmr/zjaf091

Jensen SBK, Sørensen V, Sandsdal RM, et al. Bone health after exercise alone, GLP-1 receptor agonist treatment, or combination treatment: a secondary analysis of a randomized clinical trial. JAMA Network Open. 2024;7(6):e2416775. doi:10.1001/jamanetworkopen.2024.16775

National Institute for Health and Care Excellence (NICE). Guidance on waist-to-height ratio for adults with a BMI under 35. nice.org.uk

Royal Osteoporosis Society. Risk factors for osteoporosis that you can change. theros.org.uk

Srikanthan P, Horwich TB, Calfon Press M, Gornbein J, Watson KE. Sex differences in the association of body composition and cardiovascular mortality. Journal of the American Heart Association. 2021;10:e017511. doi:10.1161/JAHA.120.017511

Zibellini J, Seimon RV, Lee CM, et al. Does diet-induced weight loss lead to bone loss in overweight or obese adults? A systematic review and meta-analysis of clinical trials. Journal of Bone and Mineral Research. 2015;30(12):2168-2178. doi:10.1002/jbmr.2564

Disclaimer:

This content is for educational purposes and isn’t a substitute for medical advice. I am not a clinician. Please check with your doctor before trying new exercises or taking health advice on this page; especially if you have osteoporosis, a diagnosed condition, or any concerns about your health.

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When I got my bone scan referral, I was fortunate. I had a student doctor the day I contacted my surgery about my risk concern.

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I was 52, and considering HRT due to menopause ‘madness’. Okay, I am being flippant - but let’s just say I felt like I was losing my brain.

(Quick note: HRT gave me my brain back, yay!)

I also had a suspected foot fracture. If you’ve read my free guide on bone health myths, you’ll know that I twisted my ankle in a STEP class, and while the movement was minor, the injury was substantial.

I was aware that HRT can stabilise bone tissue loss, and since I believed I was at risk, with osteoporosis in the family (there is a strong genetic link), I was getting in touch with my GP to look at my options.

My lucky day

As I say, I was given an appointment with a student GP. So, I brazenly requested a DEXA scan because I wanted an ‘assessment’ of my bone health, before making a HRT decision.

Based on the familial risk, he referred me. It’s a good job, because it turned out I was right to be concerned - the result came back that I had osteopenia, with a -1.3 overall T-score (although, I have since found out that the T-score doesn’t tell you everything, and there are other metrics that we can look at, as I discovered in this Substack article).

If it had been my own GP I’d have seen on that day, she would not have referred me for the scan. She actually told me that herself before looking at my records, admitting to a systemic gatekeeping issue she probably shouldn’t have been. True story.

What typically happens…

Most women - since we proportionately suffer far more from low bone density - do not get as lucky. The shoddy thing about osteoporosis is that it is usually diagnosed at a stage when medical management through prescription medicine appears to be one of the only treatment options.

Not only does it tend to be diagnosed when treatment (as well as reversal) options become limited, data from the Royal Osteoporosis Society tells us it is often when multiple fractures have already occurred.

I know from emails I’ve received from women, that once multiple fractures have occurred, life can be very difficult indeed. Severe pain, loss of independence, body and posture deformity, and loss of height are just some of the factors that make their lives miserable.

Aince I began writing and educating on bone strength and health, and launched my free guide, I have had many emails - all telling a similar sad story.

We certainly need to get assessed sooner, if any risk factors apply.

Before your next GP appointment:

If these apply to you, here are a few things worth mentioning to your doctor:

• A family history of osteoporosis or fractures

• An early menopause or surgical one

• A previous fragility fracture (a break from a fall from a minor event)

• Long-term steroid use

• A BMI that’s been persistently low

• Long term smoking or excessive alcohol use, especially if combined with any of the above

None of these mean you have osteoporosis. They’re simply worth speaking about, because a GP can only act on what they know to ask about. Remember, I got referred because I asked, not because anyone prompted me to.

Please do share this post if you’re so far finding it helpful, as others might, too.

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Menopause and bone loss is a long established fact

In the first decade after menopause, women lose bone tissue at roughly the rate of 1.5 to 2.5% a year. This is a well-documented acceleration and the health systems know about it. Yet still, by the time most women have a DEXA scan, it’s an osteoporosis diagnosis they get - not an osteopenia one.

One of the things we need to be doing is educating women to be more aware and sooner. Whether their doctor will listen is another matter (and I’m saving my thoughts about this for another article) - but any woman in her 30s or upwards should be doing something now about her bone health.

And what about the fellas?

I don’t want to leave them out. Even while men are far less likely to get osteoporosis, with around 80% of cases being women, they can still be diagnosed with it.

Because of the fact that the medical profession also assume them not to be at high risk as women, they can slip through the net even more easily.

At least half of men with osteporosis have an underlying condition which causes it, and the Royal Osteoporosis Society produce some good information on the topic to help men learn more.

One in five men over the age of 50 will break a bone due to osteoporosis, so the figure is not insignificant.

Get started on prevention, scan or no scan

Multiple recent meta-analyses (2025) confirm that resistance training measurably improves bone mineral density at the spine, hip, and femoral neck in postmenopausal women, with high-intensity training three times a week showing consistent benefit.

So what this means is, if you know yourself to be currently reasonably healthy - don’t wait for a scan, or a diagnosis, to begin a training programme that protects your bones. Honestly, you can’t afford not to.

It’s a well known statistic that one in two women over 50 will suffer a fragility fracture during their lifetime, as I talked about in my article about osteoporosis being an insidious disease - and if you have already fractured, as explained above, your options are thin on the ground.

I’m not a doctor, and I can’t comment on whether anyone’s individual treatment plan is right or not, but I am a prescriptive exercise coach - I’m qualified to train people with osteoporosis, and to have doctors refer them to me for exercise programmes.

And I urge you - please just start training. In which case, you may never need a scan - never mind a scan that comes too late.

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Disclaimer:

This content is for educational purposes and isn’t a substitute for medical advice. I am not a clinician. Please check with your doctor before trying new exercises or taking health advice on this page; especially if you have osteoporosis, a diagnosed condition, or any concerns about your health.

Are you a gym bunny, doing classes every week? Or out in the countryside, cycling every weekend? Or in the fast lane at the pool, splashing everyone with your front crawl? Doing all this and telling yourself it's protecting your bones?

I used to think exactly the same thing. It turned out I was wrong, and the reason why really surprised me.

If you read my story, you’ll have found out that for years before I was diagnosed with osteopenia, I was pretty much a ‘cardio queen’. With full gusto, I pounded the studio floor at my local gym several times a week.

I absolutely loved my Zumba, STEP, swimming and - best of all - SPIN. I would try to get to spin a couple of times a week. Pilates as well, if I could get booked in (it was always full!).

I totally believed that I was building both strong muscles and probably, if I’d bothered to think about it, strong bones. Bearing in mind, I was also doing heaps of hill hiking.

I was so fit that when I hiked up Ben Nevis in July 2021 it actually felt really easy. The photo heading this article is me at the top of Nevis. What a day!

This was all ‘weight-bearing’ exercise, wasn’t it? Well, as I found out - nope.

When ‘weight-bearing’ isn’t ‘weight-bearing’

I might have been bearing my own weight as I hiked up mountains or held an isometric Pilates move, but it wasn’t doing the job I believed it to be doing.

There is evidence to show that exercises like brisk walking, swimming, and jogging may help to limit bone loss, but such activities do not provide the mechanical load needed to stimulate bone tissue growth enough to combat accelerated loss.

Not that I got into fitness specifically to build bone. I mostly hadn’t thought about it, to be honest. Though I would do a little smug nod to the idea that I was exercising in a ‘bone-friendly’ way, whenever something came up in conversation, or whatever.

I actually got into fitness because I had begun working as a funeral celebrant. If there’s one thing that working in the funeral industry teaches you, it is that life can certainly be short. Especially if you don’t look after yourself.

What the dead can teach the living

Getting into funerals in 2017 was a bit of a wake-up call - “this could happen to you if you don’t start looking after yourself” is the message I was receiving. Loud and clear.

I wasn’t in the best of shape at that point in my life. I was overweight, and while I did enjoy walking (I always have, especially as I’ve always had dogs), and dancing too, I was definitely not ‘fit’.

I had met the man who became my husband just a couple of years previously, and we had LOVED food, and snacking. As well as beer and wine. I put on a few ‘happy in love’ pounds.

But in my funeral work, I was being repeatedly shown that poor lifestyles can equal early death. As a fairly consistent reminder, you’d have to be made of stone, or fully head-in-the-sand, to not take note.

Putting the work in

I got disciplined. I joined a local gym and started attending classes. I’ll never forget going to my first ‘Legs, Bums and Tums’ and, shamefully, had to leave the class after ten minutes because I was unable to keep up.

Even that ten minutes left me with three days of severe DOMS (delayed onset muscle soreness), too! Hard to believe I was ever like that now, as DOMS is a very rare occurrence for me, and only happens when I’ve had a training break.

But I persisted, and ultimately, I built a very strong cardiovascular system, along with amazing endurance for distance and hill walking.

What I didn’t realise was that it should have been only a part of my overall health routine. I had no idea at the time how important strength training was.

And because I had no idea, when it came to me getting my bone scan, part of me was convinced that I’d be told that I had nothing to worry about.

I was shocked with the report. I had osteopenia. What?

What I got wrong

Here’s the thing - cardio work builds your heart and lungs. That’s why it’s called cardio. It’s absolutely essential to a healthy active life, but it’s not the only thing we need.

There’s some impact included, but the body quickly adapts to the type of low-level impact provided.

Research shows us that bone needs impact, or to be heavily pulled against by the muscle (resistance), in order to grow new bone tissue.

Not only that, the stimulus has to keep changing - and be ‘continuously novel’. The stimulus should be in the form of mechanical load providing resistance.

Since some of the foundational theory on this was published, a stack of evidence-based literature through the years continues to support this.

Like anything though, you only know it if you know it. When I started out as a fitness newbie, I didn’t really understand that strength training was a necessity. Particularly as a woman in her early 40s.

Let’s face it, the fitness messages that we women generally receive - and only more recently has it started changing - are all about “do cardio, lose weight, punish yourself for eating the cake”. Am I right, or am I right?

I mean, there’s a whole article there in itself, and I shall probably get it written at some point, but suffice to say - it took an osteopenia diagnosis to get me to understand this.

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So what did I do?

Well, if you’re new here and this is the first article you’ve read of mine, I’ll give you the good news - I turned my diagnosis around. My follow up scan 3.5 years later showed I had a significant increase in bone mineral density and that I had normal BMD again.

Because I embarked upon a dedicated strength training programme and was consistent with my new exercise routine, I had started to rebuild bone.

It was helped by changing my nutritional intake and also by lifestyle improvements, as well as HRT, but all the evidence points to it being the actual strength training that would have made the real difference.

The other aspects that I changed will certainly help to stabilise bone loss, or reduce the rate at which it is lost, but they are not alone usually enough to make a significant increase (which in my case, it was).

Some evidence shows HRT can help slow bone loss, and in some cases modestly increase density, but again, the studies show that targeted strength training is actually the thing needed to make a significant difference.

(Note: HRT is a personal decision to make with your GP or menopause specialist, not something I can advise on directly.)

Quick check: is your routine actually loading your bones?

If you can say yes to most of these, you’re likely on the right track. If not, it might be worth a rethink.

• I include some form of resistance work, weights, bands, or progressively loaded bodyweight, not just cardio.
  

• I’m working large muscle groups against actual resistance, not just holding a position or moving at a steady pace.
  

• What I lift or the resistance I use has increased over the past few months, not stayed the same.
  

• My routine changes regularly, rather than repeating the exact same pattern every session.
  

• I could point to at least one exercise in my week that has felt challenging by the last couple of reps.

  ---

So, what does ‘targeted strength training’ look like?

Well, it can depend. It’s all relative to where you’re starting, and whether your body is always used to some patterns of exercise or not.

Resistance training is the umbrella term for training that involves the muscle pulling against a form of resistance, and therefore training both the muscle and stimulating the bone. Strength training is a form of progressive weight training that falls under this umbrella.

An effective strength training programme involves several exercises that will load your muscles on a total-body basis, done in 30-45 minute sessions, two to three times a week.

The focus should be on loading the whole body, exercises that work the posterior chain (back, glutes, legs), chest, hips, shoulders and arms.

Your focus should be on progressive overload - lifting or loading weights that increasingly get heavier the stronger you become.

For beginners, this may even be starting with simple bodyweight exercises or even some isometric holds - I have a 4 Week Bone Foundations Programme which is perfect for those who are new to this.

I hope you found this article useful, and has given you some awareness of how bone-friendly your own exercise-routine currently is. Please let me know?

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Disclaimer:

This content is for educational purposes only and isn’t a substitute for medical advice. I am not a clinician. Please check with your doctor before trying new exercises or taking health advice on this page; especially if you have osteoporosis, a diagnosed condition, or any concerns about your health.

Here’s the answer to the title in a nutshell: osteoporosis is an insidious disease because it is a silent condition. You often don’t know you have it until it’s too late.

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Osteoporosis is often known as ‘brittle bone’ disease. It occurs when we lose bone tissue. There is no pain associated with it, aside from when it’s very advanced and is causing other complications in the body, such as fracture of the spine causing pain.

You won’t notice changes in your health as a result of having low bone density.

There are no symptoms in the early stages, when it matters the most to catch it.

For most people, they know they have the disease when they have a fracture which may come about from a very minor incident. Or even worse, they will know when they break a bone.

80% of people with osteoporosis are women. The key reason being our different hormonal constitution. Menopause, when oestrogen drops, is a major time of bone density loss.

As well, women tend to have smaller, thinner bones than men to start with.

One in two women over the age of 50 will suffer a fragility fracture during their lifetime, but by the time it happens, they are already often in advanced bone disease.

This means if you are female and reading this, you absolutely must take note - because there is a strong chance that it will happen to you.

Men can have osteoporosis too, though. Since it is a lot rarer, they do tend to get missed from screening - and for that reason, it can mean they are even more at risk of going unnoticed until in very advanced stages.

According to the World Health Organisation, osteoporosis is a serious global health concern. Yet, it is a disease that in many cases, is largely preventable - even while being so prevalent.

Why is it such an issue?

Part of the problem is that people view ‘brittle bones’ as an ‘old person’s disease’, not understanding that the work to prevent it happening actually needs to be done decades before.

People find it hard enough to pay attention to their health for the things they can notice changing, never mind the things they can’t. So even if they are aware that low bone density may come to haunt them when they are older, they won’t act now to prevent it.

There are also people who think they are doing the right things but might not be quite hitting the mark. This was me before I actually got diagnosed with the stage that occurs before osteoporosis sets in - osteopenia (which is now reversed).

This is the exact reason why I created my free ebook The Bone Health Blind Spot, which explains a little more about what osteoporosis is, and when it comes to exercise, what does and doesn’t work for bones, and for prevention.

Your bones need you to be their advocate - because they only speak for themselves when it’s often too late.

If you enjoyed reading this, please subscribe here for free. Expect a weekly, informative article, and notes with useful tip and shares.

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There are some things that are obvious when it comes to bone health, and others that are less obvious.

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One very powerful secret ingredient in our bone health armoury is getting consistent, quality sleep. 

I used to teach my PT clients the whys and hows of good sleep habits, because sleep impacts on so many aspects of health.

Unsurprisingly, there’s also a link between bone health and poor sleep, too.

A study on aging carried out in England found that getting less than 6 hours a night, or more than 9 hours a night, is associated with higher osteoporosis risk and lower bone mass density. The balance between bone formation and bone breakdown is disrupted by bad sleep.

Not a revelation, really. I mean, consistent poor sleep (including sleep that is influenced by alcohol or sleeping tablets - making it ‘sedation’, rather than ‘sleep’) is linked to poorer health outcomes overall.

When sleep functions are disrupted, everything is…

There are three key ways in which sleep affects our bones, and they are also the ways in which sleep affects other aspects of our health. They are via disruptions in our circadian rhythm, our hormone regulation, and our cellular repair (with cellular repair being one of the key functions of sleep overall).

A growing body of research including night shift workers as subjects, is showing us that messing with our circadian patterns also impacts upon on our bones. We know already that even mild disruptions to our ‘body clocks’, like jetlag from flying or having consistent late nights on weekends, can cause health issues.

Hormone dysregulation is also a well known result of poor sleep. It impacts our appetite, our cortisol levels, and even reproductive function. Since healthy hormone regulation is also important for healthy bone tissue - you guessed it, consistent hormone imbalance can play havoc with our bone growth and repair.

As well, it is during deep sleep that our bone tissue gets repaired - as cellular repair occurs throughout the body at this time.

With all this in mind, can you imagine what the body of a menopausal woman is going through?

She is in the middle of a hormonal whirlwind, with oestrogen tanking, and her sleep is disrupted anyway because of that. Plus, she is likely to be sleep deprived either because of the hormonal imbalance, or the stress of dealing with menopause, or with hot flashes, or all of them.

The problems are compounding, so it is no wonder that menopausal women are most at risk of having low bone density and becoming osteoporotic.

So, how do we try and get better sleep?

It can be a difficult one to tackle because many people with very disrupted sleep are so anxious about bedtime that this in itself imposes a hurdle upon getting a restful night. However, these are my suggestions as a starting point:

1. Speak with your doctor to see if you have any deficiencies that might be impacting upon sleep, or if there is another physical cause. Dr Stasha Gominek says that vitamin D deficiency can be a key cause of poor sleep (but get tested before taking any supplements willy nilly). Of course, menopausal imbalances may also be the root cause - ask your doctor about options.
   

2. Avoid sources of stress before bedtime or during the evening. This includes getting involved with social media arguments on your phone and watching anxiety-inducing documentaries. In fact, turn your phone off at least an hour before bed to avoid the ‘blue light’ impact (which will awaken your brain).
   

3. Get your circadian rhythm into check. Do this by getting out into the daylight within the first 20 minutes of waking, perhaps having your morning cuppa on the doorstep or in the garden. Get an evening walk in as dusk is falling. Keep the lights dim in the home before bed, and as above, avoid the blue light of devices before bed.
   

4. Eat regular, protein-rich meals and stop eating at least 3 hours before bed. Protein is great for bones, for satiety, and for muscle growth and repair. It will keep you full and the older you get, the more you need it. Not having a full stomach before bed means rather than your body having to digest food during your sleeping hours, it can simply do the repair job it needs to do.
   

5. Avoid alcohol at night time. I know, I know - you think a glass of wine helps you sleep. But it really doesn’t. It sedates you. Your brain doesn’t go into the deep restorative sleep it needs, and you essentially become sleep deprived while believing you’re sleeping. Alcohol also raises cortisol levels the next day, which contribute to the poor sleep pattern even further. If you want to keep booze in your life, go for a weekend lunch out and have a glass then, instead of in the evening.
   

6. If you wake during the night - DO NOT LOOK AT YOUR PHONE OR THE CLOCK! The block capitals are necessary. I can’t stress how important this is. Avoid the temptation to restimulate your brain, and avoid the temptation to check the time. Instead, try some deep breathing. Imagine a dark pool that you are sinking into, and keep breathing yourself further into the pool. See if the relaxation can help you switch back off.
   

I hope this helps. It’s my mission to help more women get their bone health in check before they discover their bone health is already impaired. Sleep is more important than we realise for our bones, so it’s worth working on.

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