Osteoporosis, Osteopenia & Bone Health

Both describe lower-than-ideal bone mineral density, and the difference comes down to degree. Osteopenia means your bone density is lower than expected but has not reached the threshold for osteoporosis, often a DXA T-score between -1.0 and -2.5. Osteoporosis is more advanced bone loss, a T-score of -2.5 or below, with a higher risk of fracture. Osteopenia is often an early opportunity to become proactive about your bones.

Bone is living tissue that responds to how you nourish, move and support your body, so there is often a real opportunity to slow or reduce further bone loss, and in some cases to support an improvement in bone density over time. What is realistic depends on your individual situation, which is why a personalised approach, alongside your medical care, matters so much.

Osteoporosis rarely has a single cause. It usually reflects a combination of factors built up over many years, including the decline in oestrogen through menopause, nutrition and nutrient absorption, muscle mass and exercise, certain medications, thyroid or parathyroid issues, other health conditions, and genetics. Part of our role is helping identify which of these may be most relevant to you.

Healthy bones need far more than calcium. Adequate protein, a range of vitamins and minerals, and a varied, nourishing diet all support bone formation and strength. The right approach is individual, and it also depends on how well your body is absorbing nutrients, which is something we assess as part of a personalised plan rather than a one-size-fits-all diet.

No. Calcium is important, but it is only one piece of the picture. Your bones also rely on protein, vitamin D, other vitamins and minerals, hormones, and the mechanical loading that comes from movement and resistance exercise. Focusing on calcium alone overlooks much of what keeps bones strong.

Oestrogen helps regulate bone metabolism, so as it declines through menopause, bone breakdown can speed up and bone loss can accelerate. This makes the years around menopause an especially important time to be proactive about nutrition, protein, muscle strength, weight-bearing exercise, vitamin D and your other individual risk factors.

A DEXA scan measures bone mineral density and is an important starting point, though it does not tell the whole story. Depending on your situation, a fuller picture may also consider bone turnover markers such as CTX and P1NP, vitamin D and other pathology, thyroid and parathyroid function, nutrient status, and your muscle, strength and movement. We only recommend testing that will genuinely help guide your care.

Bones respond to being loaded, so resistance training and weight-bearing or impact exercise are particularly valuable for supporting bone strength, along with balance work to help reduce falls risk. The right type and intensity depend on your current fitness, your bone density and any other health considerations, so it helps to build an approach suited to you rather than a generic program.

Functional medicine does not replace your medical osteoporosis care. What it can do is work alongside your GP or specialist to explore and support the broader factors influencing your bones, your nutrition, hormones, gut health, muscle and overall health, so you have a personalised strategy and feel more informed and supported in protecting your long-term bone health.