Low Bone Density and Perimenopause: My DEXA Scan at 48
Low Bone Density and Perimenopause: The Number Nobody Warned Me About
Low bone density and perimenopause are connected in ways I was not prepared for, and I want to start with my mom.
She told me to get my bone density checked. Not dramatically, not with a big story attached. Just a mention, the kind of thing a mom says and you file away somewhere in the back of your brain. She had been dealing with her own bone density issues — hers has gotten serious enough that she gets injections every six months now. I did not think much of it at the time as I was active and had been running for decades. I figured I was fine.
But I got it checked anyway. And when the results came back, I understood exactly why she said it.
The 11th percentile. That is where my bone density landed. Shock was the first thing. Then fear. Then the voice in your head that starts asking what you did wrong and how you could have done better. And underneath all of it, this wave of gratitude for my mom that I still cannot fully put into words.
What Happened the Day the Episode Dropped
Last week I released an episode about gaining fifteen pounds in ten weeks while logging 940 miles of running. That same day, someone who has known me for almost thirteen years asked me if I was pregnant.
I said no. I am a 48 year old perimenopausal woman. Sorry I am not still skinny anymore. Then I went and changed my outfit. Then I went around asking basically everyone I knew at the conference if I looked pregnant. One person told me I looked hot, which saved the day a little. My people offered to trip her if she got close again. You know who you are.
I have never been asked that before in my life. I have always been a small person. And not being able to show up professionally the way I want to because nothing fits the way it should, that is its own kind of hard that I was not prepared for. I spent most of that conference in shorts and a t-shirt because nothing else felt comfortable. I am still sitting with it.
The Same Body, Two Very Different Numbers
Here is the part that makes my brain do something funny. The same DEXA scan that gave me the 11th percentile also told me that the lean muscle mass in my legs is close to the 90th percentile. The same body. 11th percentile bone density overall, 90th percentile lean muscle in my legs.
Decades of running built something extraordinary in my legs while my bones were quietly struggling underneath. The engine was strong. The foundation needed work. That is not a simple story, and it is not nothing either.
The Thread That Goes Back Further Than I Thought
This is not just a perimenopause story. When I started pulling on this thread it went all the way back to college.
I was a sub-five-minute miler back then. Under a hundred pounds. Working incredibly hard, pounding the pavement at a level I do not attempt anymore. I was late starting my period. There were B deficiencies that showed up back then too. And I ended up with stress fractures in both legs. Multiple ones.
Nobody connected any of those dots at the time. I did not have the language for it. It was just: stress fractures, take it easy, come back when you feel better. And I did, and I kept running, and life kept moving.
Looking back now I have to wonder if my body was always a little off and nobody caught it. Including me. My doctors are going to test for B deficiencies going forward, so maybe more pieces will fall into place. For now I am sitting with the possibility that some of this goes back much further than I realized.
The Vitamin D and Low Bone Density Connection Nobody Told Me
My PA explained something I had genuinely never been told before. Darker skin plus Texas sun does not equal enough vitamin D. I had always assumed I was fine because I spend time outside and live in Austin. I figured the sun was handling it.
It was not. Melanin reduces the skin’s ability to produce vitamin D from sun exposure, and without enough vitamin D your body cannot absorb calcium properly. Your bones have been trying to build on a compromised foundation. I had never taken vitamin D before in my life. Not once. I did not know I needed to.
Layer in everything else. The RED-S piece I covered in last week’s episode — under-fueling your body relative to everything you are asking it to do — is directly connected to bone health. The stress fractures in college that never got a real explanation. Decades of high mileage on a body that was probably not getting everything it needed. Perimenopause accelerating bone loss because that is exactly what estrogen decline does. It was not one thing. It was everything, accumulated over a very long time.
The Plan and Where I Am Right Now
I am not sitting with this. That is not who I am.
Vitamin D for the rest of my life, taken with calcium so it actually absorbs. Omega-3s with D and K built in because I do not eat seafood and my levels showed it. More resistance work: box jumps, lunge jumps, sprint intervals — the kind of impact that signals your bones they need to be strong. Slowing down the running. More intentional miles. More walking, even though walking does not hit the same and I am impatient about it.
I have been on HRT for a month now. Here is what I will say about that: the daily aching in my bones and joints that I had been living with is mostly gone. Dare I say, I felt normal. I did not even realize it was gone until I stopped and thought about it. That is something. I follow up with my specialist in a couple more weeks.
I recorded this episode the morning of my second iron infusion. It went smoothly, a little shorter than the first. The scale has stopped going up, if that matters. It does not, I want it to move down. I follow up with the hematologist in September to see where my ferritin actually sits, and I am learning to be okay with not knowing everything immediately. That is its own kind of work for me.
I am also still looking for a new primary care doctor in Austin. If you know someone, send them my way.
What This Whole Picture Looks Like Now
I thought I was healthy my whole life. And maybe I was, mostly. But maybe I was also always a little off and nobody caught it. Including me. My body did an extraordinary job of regulating and compensating and keeping everything together for so long. That is not a failure. That is actually kind of incredible when I stop and think about it. But it also means I was running on something less than I deserved for a very long time without knowing it.
I have more questions than answers still. The B deficiency testing is still ahead. The weight is still not moving the way I want it to. I am still processing the bone density piece and probably will be for a while. But I have more information now than I have ever had. I have a plan. I have providers who are actually looking at the full picture. And I know things about my body at 48 that I did not know at 28 or 38.
That knowledge is worth something. It is worth everything, actually.
Low bone density and perimenopause are a combination more women need to know about before they find themselves where I am.
If Nobody Has Talked to You About Your Bones Yet
Ask. Ask specifically. Get the DEXA scan. Find out where you are before you are dealing with something that has been building for decades without you knowing. Your doctor may not bring it up. Bring it up yourself.
And if you are a woman of color who has been outside in the sun her whole life and assumed that was enough vitamin D, listen to me: get your levels checked. I am telling you now so you do not find out the way I did.
I will bring you updates on all of this as I have them as I’m still in it, and not going anywhere.
Low bone density in perimenopause is not inevitable, but you have to know to look for it.
Listen to This Episode
If you are an active woman who thought she was doing everything right and nobody has checked your bones yet…this one is for you.
Listen to The 11th Percentile here:
Apple Podcasts | Spotify | jamapantel.com
Keep Listening
Start with last week’s episode if you have not yet. This one lands much harder with the full picture: Perimenopause Weight Gain: When the Math Stops Working
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