What if I told you that about $50 and 15 minutes of your time could offer valuable insight into your bone health and possibly set you up to feel your best for decades to come? Recently I blocked out my calendar and swiped my credit card hoping for exactly this.
Traditionally, patients waited for their doctors to order medical testing, but I decided to join the growing number of women in perimenopause and menopause proactively seeking (and sometimes paying out of pocket for) testing to gather data about my baseline health. And while it’s easy to get blood work ordered yearly, I was curious about the status of my bones particularly because bone health in women drastically drops after the onset of menopause. Further complicating the issue is that it’s much more challenging to regain bone strength once you’ve had your final menstrual period.
First test on my list for bone health? The DEXA scan.
What’s a DEXA scan and why might you want one?
For all you overachievers out there, DEXA stands for Dual-Energy X-ray Absorptiometry. It’s a specialized imaging test that measures your bone density and body composition — two things that will inform how you feel for the rest of your life. And, as far as medical tests go, this one’s about as easy breezy as it gets.
After chatting up the technician, I rested (fully clothed) onto a table for about 15 minutes as the X-ray scanned my body overhead. The device is fully open to the room so there’s no chance of claustrophobia like an MRI. I could have taken a nap, it was so relaxing.
When you’re done, you get a printout with lots of beautiful images of your bones and muscles plus a few key numbers. The first is your T-score, which measures your bone density and can help diagnose osteoporosis (brittle bones) or osteopenia (on your way to having brittle bones).
If you’re an active woman between 36 and 55, it’s easy to shrug off these conditions as something that happens to the little old ladies you see in the grocery store, something you can worry about later, or perhaps half past never.
I consider all of you my dear friends, so if you’re reading this, allow me to lovingly implore you to consider this test if it’s within your means. If you envision yourself enjoying an active lifestyle in your 60s, 70s and 80s (i.e. traveling to Paris or kicking everyone’s derriere in a Pilates class when you’re 75+) now is the time to pay attention to your bone density.
Another thing the DEXA measures is body composition — meaning the amount and location of muscle and fat throughout your body. This is a more accurate and useful metric than, say, BMI, which does not take muscle mass into account. Of course a small part of me doesn’t actually want to know how much fat is on my frame, but I do want to know if those heavy weights I am lifting 3 times a week are actually adding muscle.
Determining the type and location of body fat is particularly important as your body changes in perimenopause and menopause for a couple of reasons. For example, more visceral body fat — internal fat around your organs — puts you at risk for cardio and metabolic diseases. And having more subcutaneous fat (the usual type we think of that’s under the skin) around your middle vs. around your hips puts you at risk for the same. And this can be particularly challenging for women in menopause as waist thickening is a common occurrence.
Now, why did I deem this important enough to clear a Tuesday afternoon? Genetics are not on my side here. I’m a petite white woman in perimenopause — all things that put me at much higher risk for frailty, fractures, and pain as I age. (Read this to understand your risk factors.) And perhaps you are not aware that once you break a hip past the age of 65, your risk of death increases.
I’ve talked about this before, but strength training in perimenopause is like putting deposits into the bank. I may see some of the benefits today, but I’m largely doing it because I know it will pay off down the road. Your estrogen levels play a crucial role in maintaining bone density and muscle mass. As estrogen drops, the body becomes less efficient at building and repairing both muscle and bone tissue, leading to probable loss in both areas. The time is now, friends.
It turns out that the free weights I’ve been lifting have made a noticeable and measurable difference, and it’s nice to have the data which confirms that I’m on the right track with my movement program for aging with longevity in mind.
Trend alert! Our PR pro, Betsy, is not a weights person and has instead added a weighted vest to her incline treadmill sessions. I saw this substack from The Midst and couldn’t resist sharing. Have you tried rucking as part of your strength-training routine? I can’t wait to add one of these to my routine!
Why get a DEXA now?
I have a prevention mindset, meaning I want to gather concrete information about my health now so future results are more meaningful. For many, this is a test your insurance may not cover until much later, which may unfortunately be too late.
If you take the test now and happen to get results that concern you, the good news is that your doctor (and perhaps a nutritionist and fitness pro if you so desire) can use the results to help set you on the right path. And keep in mind that these changes don’t have to involve a full lifestyle overhaul (because really, who has the time or energy for that).
Additional testing to consider
In addition to the typical labs your doctor orders in your yearly physical and the screenings recommended in midlife (mammogram, A1C, pap smear, thyroid function test, blood pressure screening, yearly skin cancer screening, etc.), you may also want to gather data about other key values.
-
Vitamin B12: If you have brain fog (or even if you don’t) it is a great idea to get a baseline idea of your B12 levels. This micronutrient is incredibly important in midlife as it plays a key role in the central nervous system.
-
Vitamin D: Vitamin D is critical for strong bones and the prevention of some cancers, depression, fatigue, diabetes, heart disease, high blood pressure, and probably a lot more. A deficiency is very common and can be corrected with the right supplementation.
-
Ferritin: You’re probably less familiar with ferritin — I was. Maryann Jacobsen saved the day with a brilliant substack that explains it all. It’s a protein that stores iron in the body. Low ferritin can indicate iron deficiency – symptoms can include anemia, fatigue, and weakened immunity. High ferritin can indicate inflammation, liver disease, and other conditions.
-
Hormone Testing: Admittedly this one’s controversial. There’s no one test that can tell you whether you’re in perimenopause since hormones typically fluctuate so much in a cycle. Some providers and patients order the tests in order to have at least a snapshot of what’s happening with their estrogen, progesterone, FSH, and LH in a cycle. However, if your results come back as normal or in range and you’re having symptoms, it does NOT mean you’re not in perimenopause. Insist on treatment for the symptoms if they are disrupting your life.
What other testing have you considered? I’m a huge advocate for testing sooner rather than later so you get information in time to do something about it. Perimenopause is a time when things can suddenly feel out of control — testing is a concrete step we can all take to regain our agency.
Cheers to looking and feeling your best,
Susan Campbell
Founder & CEO, Phosis
