For many years osteoporosis was viewed as an "old woman’s disease" that typically affected females after the age of 60 or 70. However this perception has changed. More and more women in their late 30's and 40's experience early signs of reduced bone density. These include: frequent back pain, loss of motion or mobility, fractures even with very minor falls, weakened teeth, and generalized joint pain without an obvious cause. Bone density can change with time. Bones are dynamic - they are made up of living cells that respond to various forces and stimuli through the process of bone turnover (remodelling). Most women can maintain or increase their bone mass until approximately 30 years of age. After age 35, however, the body’s capacity to replace lost bone with new bone gradually declines, and most women will start to develop a negative balance of bone density. Dr. Sharmila Tulpule, Founder & Director, Orthobiologix Biotech Pvt. Ltd and Orthopedic Surgeon & Regenerative Medicine Specialist shares reasons why it happens and ways to deal with it.Why women lose their bone density earlier than menHormonal change is one major reason for this accelerated loss of bone density. Estrogen has a very important role in retaining bone density, and as women's bodies produce less estrogen (aka perimenopause and menopause) over time, it causes a higher rate of bone breakdown and much slower rates of new bone formation. But the problem is not just hormonal. Modern lifestyle habits are an additional factor contributing to losing bone strength at more rapid rates and at younger ages. Urban women routinely are participating in sedentary working conditions, sitting continuously for long time periods; generally engaging in very low rates of physical activity; crash dieting; consuming insufficient amounts of protein; chronic stress; smoking; drinking alcohol; and experiencing deficiencies in vitamin D.Many women today are also dealing with hormonal conditions such as hypothyroidism or type 1 diabetes, complications due to pregnancies being delayed as well as disrupted sleep patterns and elevated stress levels, all of which indirectly affect the metabolism of bone and how effectively bone can recover from injury.The hidden importance of muscle healthOne contributor to weakness in the bones that isn’t well known is that, by not being physically active and avoiding full body strength training, women often lose muscle mass, which provides mechanical stimulation to the bones to assist them in being strong. Extreme dieting and not eating enough food also results in women not being able to consume the essential nutrients such as calcium, magnesium, vitamin K2, and protein necessary for the overall health of the bones. Another problem with losing bone strength is that there are usually no clues to tell women that they are losing bone density until after they have broken a bone or are in chronic pain due to a broken bone or have already developed osteopenia or early progression to osteoporosis. The significance of early screeningPreventative screening post-35 is very much on the rise especially when it comes to women who have a family history of osteoporosis, autoimmune disease, early menopause, nutritional deficiency or prolonged use of steroids. Bone Mineral Density (BMD), as well as Vitamin D, calcium profiling and evaluation of lifestyle factors, can contribute to finding early stage deterioration before considerable damage occurs. Earlier stages of bone loss increase the chance of being able to slow the rate of worsening and avoid long term consequences.A holistic approach is essentialA holistic approach to nutrition, health and wellness is vital. Bone health is achieved using a multidisciplinary approach. One of the most effective ways to preserve bone health is through strength training and other forms of weight-bearing exercise which stimulate the remodelling process of bone. Equally as important are having adequate protein (another form of nutrient) intake, optimization of Vitamin D levels, having hormonal balance and consuming anti-inflammatory foods. Women need to be aware that menopause is not when they will start to lose bone mass; rather, it is the time that they will see the many years of gradual bone loss come to fruition. Women's bone loss can begin years before menopause; therefore, prevention should not wait until the late 40s or 50s to begin.The future of women’s bone healthWomen today enjoy a longer lifespan, continued employment, and increased participation in traditional physically demanding activities later in life than in previous generations. Therefore, treating bone health is no longer limited to just preventing potential fracture; rather it will now also involve continuing an individual’s right to independence, mobility, productivity, and quality of life. We anticipate that future developments in orthopaedics will include prevention medicine, preventive lifestyle approaches, sophisticated diagnosis methods, hormonal evaluation tools, all being treated in much more individualised ways than previously offered.Bone deterioration after age 35 should never be considered just the “normal process of ageing.” It is often your body signalling through lowering hormone levels and metabolism that potential problems exist with your systemic balance, including metabolism or lifestyle. By prioritising bone care now as part of your overall wellness program you have created opportunities to maintain your mobility, strength, and long-term health.