What to Know About Bone Density in Your 20s and 30s

You’ve heard of osteoporosis and you know bone health is important, but in general weakening bones can feel like, well, a future you problem.

Turns out, this isn’t exactly the case.

The sex hormone estrogen plays a key role in maintaining bone strength, which is why the majority of bone loss for women occurs after menopause, when estrogen levels fall. But certain medications, conditions and family history can lead to low bone density in younger women. 

From testing to differentiating between different types of bone loss, here’s what you need to know about your bone health. 

Can you get osteoporosis or osteopenia in your 20s and 30s?

The answer to this question is a little complicated. Yes, younger people can have low bone density, but technically no, it isn’t considered osteopenia or osteoporosis. 

Osteopenia and osteoporosis are medical terms that categorize ranges of bone density across the spectrum, from healthy bones to weak or fragile bones. On that spectrum, you go from healthy bones to moderately low bone quantity (osteopenia) to very low bone quantity (osteoporosis). But these terms don’t technically apply to younger people.

“If you are being exact, then you wouldn’t use the term unless a woman was post-menopausal or a man was over 50,” says Dr. Julie Carkin, director of the Osteoporosis & The Strong Bones Program at UW Medical Center – Northwest and a physician at the Seattle Arthritis Clinic. 

This gets a little sticky because pre-menopausal women (and young men and even children) can still have low bone density compared to their age-matched peers.

So while you technically can’t have osteoporosis or osteopenia in your 20s and 30s, you absolutely can experience dangerously low bone density compared to your peers.

What leads to low bone density in younger women?

There are a couple different culprits of bone loss and low bone density for those in their 20s and 30s.

“Smoking is really bad for bone, as is excess alcohol and certain medications like antiseizure medications. And steroids are the worst,” Carkin says. 

Certain medical conditions like celiac disease or Crohn’s disease can also decrease bone density by preventing you from absorbing the nutrients you need. Similarly, if you currently or previously have had an eating disorder, this can lead to lower bone density. And a family history of osteoporosis could mean you have genes that prevent you from reaching a healthy peak bone mass. 

If you have one of these conditions or you’re concerned about body density because of your family history, reach out to your doctor and ask about screening for bone density.

How do you test for low bone density?

Hold tight, things get a little more complicated here before it all makes a lot more sense.

Bone density refers to the amount of minerals (calcium and phosphorus) in your bone tissue, and for women, peak bone density occurs by age 30. This means if you’re testing to see if you have healthy bone density, you are comparing the density of your bones to the average, healthy 30-year-old. 

Doctors do this through a dual-energy X-ray absorptiometry scan or DEXA scan. 

“A DEXA scan measures bone in weight,” Carkin says. “So, in a standardized position, the spine and hip are scanned and then the technology can tell how much mineral there is, or your bone mineral density.”

Your doctor will then compare your bone mineral density to a national database, which gives you a score for your bone density.

For menopausal women and men over 50, this score is called a T-score. Doctors use T-scores to compare older individuals’ bone density to an average of healthy 30-year-olds. 

But a T-score isn’t helpful for younger individuals.

“You definitely don’t want to use a T-score if you have a young woman who is 22 years old and not at peak bone mass,” Carkin says. “What you really want to know in someone like that is are you on track with your peers or are you below your peers.” 

Basically, because younger people have not reached their peak bone mass, T-scores are not accurate measures of bone density for younger folks.

Instead, bone density is calculated by a Z-score, which compares your bone density to what is considered a healthy norm for people your age. From there, your doctor will be able to tell whether you are in a healthy range or not.

What can you do to prevent or manage low bone density?

Carkin likens bone density to a bank account.

The more you can deposit into your bone bank account now, the larger reserve you will have when you make withdrawals later in life. For your skeleton, this means that if you increase your bone density now, then after menopause, when you lose estrogen and bone density, you will still have strong enough bones to prevent breaks. 

So, what can you do to bolster that account?

If you smoke or drink, one straightforward option is to work with a doctor to reduce and stop these activities. 

Other crucial factors include getting enough calcium and vitamin D. 

You can get a healthy calcium intake through dietary sources like dairy products, almonds, salmon and foods fortified with calcium. For vitamin D, which is harder to get through diet alone, Carkin recommends talking with your doctor to find a vitamin D supplement with the right dosage for you. 

For those who have a condition that decreases bone density, or who are taking prescriptions such as steroids that can cause bone loss, another option is to talk with your doctor to see if there are different medications you could try. 

“If a person has any kind of medical condition that affects their absorption of food or nutrients, or takes a medication that is adverse for bone, it’s good to have a conversation with the treating physicians about ways to optimize bone,” Carkin says. 

Eating a nutritious diet and exercising can also increase both bone density and muscle strength, which helps prevent falls. Though weight-bearing exercises are great, other options like swimming, yoga or going on walks still make a big difference, Carkin notes. 

Working with your doctor can help you find the right balance of lifestyle and medication changes to promote skeletal health. Even small changes can go a long way to increase your bone strength and help future you avoid fractures, too.