My DEXA Scan Still Says Osteopenia

The DEXA scan report lands and my heart sinks for a second - I’m still osteopenic. But when I slow down, look properly at the data, and then dive into the research, the story changes completely and it becomes one of the most useful mindset lessons I’ve learned about women’s health in perimenopause and menopause.

My spinal bone density has increased by 3.5% over two years. My femoral neck improves slightly, my hip stays stable, and nothing points to a concerning downward trend. We talk about why bone remodelling is slow, why single-digit percentage changes can be meaningful, and why DEXA scans have normal measurement variability. I also explain why it matters to scan at the same facility and what “least significant change” can add to the conversation, so you’re not judging your progress on a label alone.

Then I share what I think is helping: menopause hormone therapy under medical guidance (including the evidence for body identical estradiol and why different products aren’t interchangeable), progressive strength training with proper progression, and the value of a personal trainer if you’re managing injuries or you need help lifting heavy safely. We also zoom out to nourishment and bone health nutrition, including protein and key micronutrients, plus my concerns about muscle and bone loss being discussed around GLP-1 weight loss injections when food intake drops too far.

If you’re chasing a health goal and feeling like you’re “not there yet”, this will help you measure what matters: the direction you’re travelling, not just the finish line. Subscribe or follow, share this with a friend who needs stronger bones, and if it resonates, leave a five-star review or DM me on Instagram with your biggest takeaway.

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Transcript

Welcome And Why Bones Matter

SPEAKER_00 0:00

Hi, I'm Susie Garden and this is the Ageless and Autumn Podcast. I'm an age-defying naturopath and clinical nutritionist and I'm here to bust myths around women's health and ageing so that you can be ageless and autumn in your 40s, 50s, and beyond. The Ageless and Awesome Podcast is dedicated to helping women through perimenopause and menopause with great health, a positive mindset, and outrageous confidence. Hit subscribe or follow now and let's get started. Hello, gorgeous one, and welcome to this week's episode of the Ageless and Awesome Podcast. I'm Susie Garden, Perimenopause Naturopath, weight loss nutritionist and founder of the Perimenopause Path Clinic. And if you listened to last week's episode, you'll know that uh this time last week, I'd just had my two-year follow-up DEXA scan. Two years ago, I really campaigned to get one of these DEXA scans. So they're a bone density scan. And I don't really have risk factors, but I just really wanted one. You know, I'm a healthcare professional. I've read a lot about all of the things that we need to look after when we hit menopause, and bones was something I just really wanted to check on. And when I had that DEXA scan done, I was actually super surprised, but I came up as osteopenia, which is kind of the stage just before osteoporosis.

DEXA Results And First Reaction

SPEAKER_00 1:35

So I recorded that episode on the day I had my scan done, so I didn't have the results, and I promised I'd come back and tell you how it all went. So here we are. The results are in. I actually only got the report today, and my first reaction was, oh man, I am still osteopedic. And I'll admit it, I was actually just really quite disappointed. Um, because I have spent the past two years actively working on my bone health, thinking about it every single day, doing all of the things that the research tells me is going to help. Um and somewhere in the back of my mind, I really thought I would open this report and see that I was at normal bone density, osteopenia gone, job done, all good. Uh, that's not what happened. Uh, my spine is still in the osteopenic range, and which it was last time, and initially that's all I saw. Uh, and then I looked more closely at the scan itself and what had actually changed over the past two years. And of course, there is good news. My spinal bone density, which is the one I was super concerned about, has actually increased by 3.5%. My ephemeral neck has also improved slightly, although it wasn't in the osteopenic range last time. So, but it's still still improved, which is great. Uh, my hip is essentially stable. So I'm not losing bone. I'm not. I'm moving in the opposite direction. And so suddenly I just thought, well, hang on, this is actually a pretty good result. Um, but naturally, of course, the clinician and me kicked in and I wanted to know well, okay, is three and a half percent improvement over two years actually good? Is it below average? Should I have improved more? Is what I'm doing working? Do I need to be doing something differently? And so I went down a bit of a PubMed rabbit hole. PubMed is where all of the clinical research data kind of sits. And what I discovered really did change the way that I looked at my results. And that's what I wanted to share with you today. Because I think there's a lesson here that goes far beyond osteopenia. So I was really looking at the wrong measure of success. Here's what I'd done: I'd reduced two years of work, two years of work that I had done to work on my bone health to one question. And that question was, am I still osteopenic? And the answer is yes. Therefore, it's not good enough. And then when I realized I'd done that, I kind of laughed at myself a little bit because this is exactly what we do with our health all the time, right? I see this in my clients all of the time. You want to lose 12 kilos, you lose five. Instead of thinking, oh, I've lost five kilos, you can still go, you go, I've still got seven to go. You start strength training like I did, and you're lifting twice what you could six months ago, but you're frustrated because your body doesn't look exactly the way you want it to yet, you know, rather than celebrating that you can actually lift twice what you could six months ago. Let's say your cholesterol, I see this all the time with cholesterol panels in my clients. Your cholesterol improves significantly, but one marker is still outside the optimal range. So you think, ah, it didn't work. What I'm doing doesn't work. We can become so fixated on the destination that we completely overlook the direction we're traveling. And I'm talking also to my fellow type A personalities here that we, you know, the high achievers, we want to get the goal, we want to get things right. And it can be really disheartening when we don't get that destination in the time frame that we think we should.

Measuring Progress Not Labels

SPEAKER_00 5:40

And that's what I'd done with my bones. You know, two years ago, the T-score in my spine, and I explained all of these scores last week, so I'm not going to do it again. Uh, two years ago, the T-score in my spine was minus 1.8, and now it's minus 1.6. And technically, both numbers are still osteopenia, but they're not the same result. I'm moving towards normal, I'm not away from it, and that distinction really matters. So is three and a half percent actually good? So that was my first thing. Once I got past my initial disappointment, I wanted to know all right, is three and a half percent a decent improvement or not? Because it honestly, three and a half percent does not sound particularly dramatic in terms of an improvement. I mean, if someone told you that improves something by three and a half percent over two years, you know, you might think, is that it? But bone doesn't change rapidly. We're not talking about losing five kilos in eight weeks. Bone is living tissue that remodels slowly. And so when I started looking at clinical trials of bone density and the kind of activities that we know will improve it. And when we looked at those, the research, when I looked at the research and what the researchers were measuring, they were often single-digit percentages. So I was pretty happy about that. I had, you know, really expected a dramatic transformation in a tissue that simply doesn't work that way. Um, the other thing is DEXA scans aren't perfectly precise. There's a certain amount of normal measurement variability between scans. So technically, before I can say I've definitely grown 3.5% more bone in my spine, I actually need to know whether that change exceeds what's called the least significant change for the facility where I was scanned. So when I uh asked my doctor for the referral to get the test done again, she said, make sure you go to the same facility. You're gonna be on the same machine, get the same, it's a better comparison. So, what I need to find out is that facility's um least significant change number, because that actually gives context to my 3.5% to see if it's actually significant or whether it's not really much at all. So I'm gonna find that out. But even allowing for that, the overall picture is encouraging. My spine measurement has improved, my femoral neck measurement has improved, my hip is stable, and my femoral neck and my hip are both in the normal density range anyway. So I I'm not really looking for improvements there. Um, nothing showing a concerning downward trend or anything like that. I haven't stayed the same. Um, and given that menopause is a time when women can actually be losing bone, you know, I feel very differently about these results now than I did when I first looked at them. So let's talk about what I think has helped. This is probably the more practical and interesting stuff because obviously I want to know what have I done over the past two years that may have contributed to this? So I need to put my clinician hat on here for a moment, and I can't tell you that the one particular thing increased my bone density. I'm one woman, I'm not a randomized controlled trial, there is no placebo group. I've made a number of changes, I've followed the research, so I can't say what particular thing caused my improvement. Honestly, I believe it's a combination of everything that I've been doing, but I can certainly look at what it is that I've done and ask what's got the evidence behind it. Spoiler alert, everything. Um, but the few that really stand out, and one that may seem controversial because I am a naturopath is uh menopause hormone therapy. What that's been a big change for me. Um, if you listened last week, you'll remember why estrogen matters so much to our bones. And I'm not going to go through that physiology again. That episode's still live. You can go and listen to it if you're interested. But essentially, estrogen has a really important protective role in bone. And when estrogen falls, the balance between bone breakdown and bone formation shifts. And that's one reason that the bone loss accelerates once our estrogen has gone out the door. So, naturally,

What Research Says About Change

SPEAKER_00 10:25

I wanted to know what the research shows when women use the kind of hormone replacement therapy or menopause hormone therapy that I'm using. And this was really interesting. Um, there are clinical studies looking at specifically the one that I am using, including the dose that I'm using. And these studies show that it can help prevent postmenopausal bone loss and increase bone mineral density. So that's awesome. Um and the thing is, when the researchers look at changes in bone density over a couple of years with hormone therapy, we're not talking about enormous increases. We're talking single-digit percentages, which again made my 3.5% result look rather different to what I thought initially. Now, I'm not saying I used metopause hormone therapy, and therefore my spine improved by 3.5%. We can't make that conclusion. We can say that it has a well-established bone protective effect, and it's very reasonable to consider it as a part, a part of my overall bone health strategy. And, you know, there's another terminology point, I guess, that's worth mentioning. I'm using the body identical estradiol. So this is a TGA registered product. It is um uh how do I put it? It's not a compounded product, uh, it's not the it's not a contraceptive type of product, it is body identical estradiol. So if you're wanting to have discussions with your doctor about what might be right for you and what is in the research, body identical estradiol uh is one of those. I see a lot of women that come to me and they say they're on menopause hormenti, but in fact, what they're on is something similar to the oral contraceptive pill, which is really quite a different product. So just be aware of that. And be aware also with the compounded uh products and not the same things as what they use in the trial, because obviously the combatant products are generally going to be have some degree of individualization for you. Um, so they're not gonna be used in clinical trials. And I think it's really important when we're talking about evidence. Um number two, strength training. I reckon this is the game changer for me, strength training, lifting heavy, um, putting load through my muscles and bones. And this is something I intend to keep prioritizing. You know, one thing I've been thinking about since getting my results is the difference between doing strength training, which I often that's the terminology I use is doing strength training or lifting heavy things. Whereas I probably should be more specific and say progressive or progressively strength training, because they're not the same thing. As we know, our body is very adaptable, it adapts to a whole number of different environments. And that is why if you don't do any lifting, your muscles just get a bit softer, and particularly over right once you get into your 40s, really, they just start disappearing because you're not putting them in a situation where they need to adapt. So even if you are doing strength training, if you're picking up the same weight and doing exactly the same exercises, the same reps, the same intensity for two years, that's not gonna be much of a challenge for your body, for your bones, for your muscles. So it's not gonna put them under the stress that they require to change and to grow. So progressively strength training and constantly increasing that weight that you're lifting is really important. And the other word I want to use in this discussion is appropriately. Am I progressively challenging myself appropriately? And this is why I use a personal trainer because I do have injuries in my body, I have nursing injuries in particular that I've had for decades and not going anywhere. So

Menopause Hormone Therapy Explained

SPEAKER_00 14:35

I'm not trying to heal them, I am just managing them. So for me, particularly, and also I'm quite mobile. I don't know if I fall in the hypermobile category, but I'm very, very flexible. And people that are very, very flexible tend to injure easily because it feels good to stretch, but it doesn't mean that you should stretch in the way that sometimes it feels good. Uh, and particularly lifting heavy things. I want to make sure my form is really good and that I am challenging myself appropriately. And my PT pushes me to do things that I would never have the guts to do if I was left to my own devices. I would find it terrifying. So I really highly recommend finding a PT. If you're in the same situation as me and you need to be lifting heavy things, and maybe you have injuries, maybe you're not someone that's exercised much throughout your lifetime. Highly recommend getting advice, not just watching stuff on the internet for free, actually investing in someone that has invested in themselves and gotten the education and have the ability to push you to in a way that is going to be safe for you and that's going to be beneficial for your health. I think this is a really important message for women generally, is to really know how to push yourself. We have been conditioned for decades to think exercise for women should be about burning calories, right? How many calories did my workout burn? Our devices, whether you're using a ring or a watch or whatever, if you are using a device, they will always have how many calories have you burned? How many steps did I do? How sweaty did I get? And honestly, and I say I have these my clients, if they're listening, they hear me say this all the time. It's not about calories when you get to this age, not about calories in calories out. It is about getting strong. Getting strong. What is this exercise helping my body become capable of? Is it preserving muscle? Is it building muscle? Is it improving my strength? Is it challenging my bones? Because that is what's going to get them stronger. Is it improving my balance? That's why, you know, for me, my PT has me doing single-legged things because I have imbalance in my body. So I need to work one side a little bit more than the other. Um, you know, long term, I know that this is going to make me have a better quality of life. I'm still going to be able to do the things I like doing. And that's particularly has been on my mind having osteopenia because I really love mountain biking. And there's a lot of, you know, force that goes through the body when you're jumping over logs and things like that. And it makes me quite frightened to fall on the bike because I worry about breaking, particularly my spine. As I mentioned last week, it's like, oh, I really don't want to get a spinal fracture. Um, so looking at exercise from this point of view, where it is more calculated, it is not just throwing yourself into a class, it's actually going, well, what is right for me as an individual? And I'm absolutely aware of my privilege in being able to afford this. And I'm actually lucky. I have two PT sessions a week, and I actually won a competition last year uh where that second PT session has actually been free of charge to me. Um, and it will be for 12 months. So then I just have to reassess my budget. But it is something that I love. I know that I actually even said to my husband, I think it was on Friday, I don't feel like going to the gym, and this is why I have a PT, because it's my husband used to train me, and so it was very easy just to make excuses not to do gym. Uh, but when I have an appointment with someone, uh I have to go. Doesn't matter how I'm feeling in the moment, I still have to go. And that is something that's worked for me particularly very well because if I have that appointment, I will not cancel it. So, yeah, that physical move. Probably the only thing I would add to this for myself personally, if I'm thinking about putting more, is prioritizing doing a third training session at home. I tend to I go to Reforma. That has dropped away a little bit, I've got to admit, in the last couple of months, I've been getting busier, particularly with the purchase of um e-skin. My time is not as flexible as it used to be. Um, and the clinic is growing as well, which is fantastic. All of these things are really positive and I'm loving it, but I it is taking up more of my time. So I need to re-look at my schedule and recommit to this movement because it's super important. And the other thing I can add, uh, which I'm getting to, is a jumping practice. So I haven't had this. I've uh because of one of the injuries I have, which is in my hip, um, I've avoided jumping. And jumping is very, very good for bone density. So my hip's no longer that much of a pro it is a bit of a problem still, but I think I can jump. So I'm gonna start bringing in a jumping practice. And literally, it is the easiest thing in the world. Literally, all it is is jumping up and down in one spot 20 times. That is it, once a day. So I'm gonna commit to doing that to improve

Progressive Strength Training And PT

SPEAKER_00 20:05

things. Um, so number three, and this is the last one I think I'm gonna talk about, is nutrition. Nutrition is big. Uh, we covered the la the key sort of bone health nutrients last week. So I'm not gonna give you another lecture about calcium and vitamin D. Um, but what these results have done is reinforce something I talk about constantly, and that is about nourishment. We need to nourish our bodies. Uh, we don't want to be starving our bodies, and it's particularly important when women are trying to lose weight that they're not starving themselves. And one of the things I see constantly is women in their 40s and 50s eating less and less and less, trying desperately to force the scales down. And often when they start my program, the Glow Protocol, they're going, oh my gosh, this is so much more food than I normally eat. And they worry that they're not going to lose weight because they're eating more. As I keep saying, it is not about eating less and doing more. It is about having the right nourishment for your particular body and tackling things like reducing inflammation, like balancing out hormones, like um balancing out your blood sugar and your insulin management. All these things are very, very important. We do this with food, but we don't do it by restricting food. Uh, and this is the thing I'm seeing, actually, I will comment on this, is just with the the high use of the GLP ones or the weight loss injections. And it's certainly a real uh challenge. And actually, there's a sense of urgency about this at the moment in health, is the rapid rate of muscle loss and bone loss in people taking these GLP 1s. When I was in Barcelona at the nutrition conference in May, that was all people were talking about is what. What are we going to be doing to support these people who are taking these products because they need them? But you still need the nutrition to be right. Even though uh you're going to be losing weight on these medications, you need to keep that muscle mass, you need to keep your bone mass, otherwise, your quality of life is really going to deteriorate. And it really makes me sad now that I'm even seeing loads of celebrities now, the race towards being the thinnest, and you know, yeah, I just feel like it's a really difficult situation. And all I can say is please nourish your bodies. Please. Um, I'm always thinking about what's happening to my muscle now, whereas I wasn't prior to having this diagnosis. Um, but also I'm thinking, am I getting enough protein? And I do think about that a lot. Are you am I meeting my micronutrient needs and not just your uh protein and your fats and your carbs, but also things like your zinc and your iron, uh, obviously calcium. Um, you know, I want to be strong, I want muscle, I want healthy bones, I want energy, I want to travel, I want to carry my own suitcase, and I want my body to allow me to live the life I want to live. And that means the nutrition for me has to support the body I'm trying to build. And that means that pretty much I put thought into every meal now, every meal has to support the body I'm trying to build. I don't feel like any of us really can afford to take too much for granted. And if, you know, when I I do food diaries with women, they're generally appalled when they see how much takeout they have or how much um they are not eating fruits and veggies, for example. So it's it's important to really look at the nutrition you're eating on a daily basis. And really, I know that seems like, oh God, really another thing I've got to look at, but it's actually a really important one. A really, really important one. So the question I really want it answered is do I need to do more? So if my spinal bone density has improved by 3.5%, but I'm still osteopinic, does it mean I'm not doing enough? Or does it mean what I'm doing appears to be working? So keep going. So at this stage, I think it's much more the latter. Um, nothing in my results is making me think that I need to panic, that I need to ramp things up dramatically. In fact, quite the opposite. My trajectory appears to be heading in the direction I want. So rather than asking what else can I add other than a jumping practice, I'm asking about myself, like, can I optimize what I'm already doing? And that's a really important distinction. Because there's always gonna be another supplement, another biohack, another person on Instagram promising to rebuild your body in six weeks or whatever. And I know that that's not gonna happen. I'm not interested in chasing all of that. I just want to know am I consistently doing the things with the strongest evidence and can I do those things better? So, my plan is I'm gonna continue with my hormone therapy under the guidance of my doctor. I'm not gonna change my hormone dose myself because of a DEXA scan. I tell you, it did cross my mind. Um, but I have a fantastic uh menopause doctor, and I always just listen to her. Definitely gonna continue my strength training and I say this. Think about what's what am I saying? Think about adding a third session. I have to add a third session. I do. Um uh I have to make sure I'm continually challenging myself, and that means keeping my PT. Um, I'm gonna make sure that I'm continuing to take the supplements that I mentioned last week. I'm gonna continue prioritizing protein. Um, this is a long-term project. This is a long-term project. It's probably actually going to be a lifelong project because even once I get to the point where my bones are normal, and that is gonna happen. I suspect in my next bone scan, which will be in another two years' time, uh, that it will, I will have reversed it. And but then I just have to keep going. I just have to keep going. Because I'm investing in the woman I want to be in 10 years, in 20 years, in 30 years from now. And that's actually quite motivating. I would love when I get, you know, I'd love to be thanking my past self in 10 years' time for what I've been doing for my future self. Um, and another thing I've decided, I'm not going to spend the next couple of years obsessing about my scan. I've really been giving a lot of thought to my scan. Actually, this time last year, I was like, maybe I can get a scan in between. Because I'm paying for it myself. It's like, well, I don't know. But honestly, you won't see that much change. It does take time. Um, so yeah, but I guess what how I'm changing about how I'm thinking about the next scan is I'm not actually now shooting for reversible osteopenia. I'm just shooting for continuing to improve my bone density. And that will keep me safe. I'm happy about that. Um, if my bone density remains stable through a period of life when I could otherwise be losing bone, that's really meaningful to me. If I'm stronger, that's a success. If I'm lifting heavier, that's success. If I'm maintaining my muscle, that's success. And if I'm reducing my future fracture risk, that is awesome. So my goal is to be a strong, active, independent woman for as many decades as possible. And the women in my family live till their 90s, so it could be quite some time. Uh, and I'm looking at the DEXA scan as just being one of the tools to help me understand whether I'm moving in that direction or not. So, one final thing that this experience taught me, and it's probably my favorite part of this whole conversation. When I first opened those results, my reaction was that's not good enough. But despite the numbers actually being better, I thought, oh man. You know, and started beating myself up. Well, I should have done more. But this is exactly what women do to themselves all the time. You lose four kilos, but I needed to lose another eight. Your waist gets smaller, but I'm still not back in my old genes. You're sleeping six and a half hours instead of four. It's like, but I'm still waking up. Your energy is dramatically better, but I'm not back to how I felt at 30. We move these goalposts constantly. And sometimes we're so focused on where we haven't arrived, is that we completely fail to notice how far we've traveled. And I'm having these conversations with my clients all of the

Nutrition Nourishment And GLP-1 Caution

SPEAKER_00 31:01

time. Now that doesn't mean that we settle. I'm still osteopenic and I'm taking that seriously and I'm gonna keep working on it, but I'm also not gonna turn this improvement into a failure simply because it wasn't a complete resolution. I think there's a really lovely middle ground where we can say, this is better, I'm really pleased with the progress, and I'm gonna keep going. Both things can be true. So, what I want you to take from this whole experience, and you know, you could be listening to this, you've never even thought about your bones, you don't have osteopenia, maybe you've never had a DEXA scan. That's okay. Because I think this lesson applies to almost every health goal that we have. Whether you're working on your weight, your blood sugar, your blood pressure, your cholesterol, your fitness, your sleep, your hormones, your strength, your mental health, uh whatever it is that you're working on. Don't only ask, have I reached the goal? Ask which direction am I traveling? Because sometimes you genuinely do need to change your strategy. If you've been doing something consistently and objectively nothing is improving or things are getting worse, that's important information. But sometimes the strategy is working, your body simply needs more time, and that's particularly relevant when we're talking about something like bone. Biological change takes time, and our bodies don't care that we'd really like a particular result by whatever the timeline is. So, where does this leave us? Um obviously, I still have osteopenia in my spine. That's only half the story. The other half is my spinal bone density has increased by 3.5% over two years. My ephemeral neck has improved slightly, my hip is stable and the overall trajectory is encouraging. Would I have loved to come on here and tell you I'd completely reversed my osteopenia? Absolutely. But I'm no longer disappointed by these results. I'm actually feeling pretty positive about them because I have evidence that I'm heading in the direction that I want to go. And now my job is to keep going. Not frantically, not perfectly, just consistently. And perhaps that's the message I want to leave you with today. Sometimes progress doesn't look like arriving. Sometimes progress simply looks like moving in the right direction. And when it comes to our health, I think we need to get much better at celebrating that. And I'll continue sharing my own Bowden health journey with you because apparently we're all invested in my decks of results now. And I hope that by sharing the reality, including the bits that initially disappoint me, it helps you think differently about your own health journey too. Now, if you haven't listened to last week's episode, go back and have a listen because I explain, it gives you a lot of background for this episode. I explain osteopenia, why bone loss accelerates around menopause, what we can actually do about it. And if you know another woman in her 40s or 50s or beyond who needs to hear this conversation, please send these two episodes to her. Because the time to start thinking about strong bones isn't when we're 75. It's now. So thank you for hanging in there and spending this time with me. Um, I appreciate it. Uh take care, stay well, and I'll see you next week with some fresh new content that will not be about me. Thanks so much for joining me on the Ageless and Awesome Podcast. If you would liked this episode, please make sure you click the little plus button if you're on Apple Podcasts, or the follow button if you're on Spotify, so that you get each new episode delivered to you every single week. If

Long Game Mindset And Listener Actions

SPEAKER_00 35:01

you feel like writing me a five star review, you would absolutely make my day. If you found this episode resonated with you, head over to my Instagram and DM me at the Perimetopause Park. I would love to connect with you.