How to Holistically Heal Osteopenia & Osteoporosis

If you’ve recently been told that you have low bone density or you’ve had a DEXA scan and seen terms like osteopenia or osteoporosis, it’s important to understand what they mean. These conditions often develop silently, but they carry significant long-term health implications. Early awareness and understanding can help you take proactive steps to monitor and care for your bones.

What Is Bone Density?

Bone density refers to the amount of mineral content, primarily calcium and phosphorus within your bones. It reflects the strength and structural integrity of your skeleton. Dense bones are strong and less likely to break, while bones with reduced density are weaker, more brittle, and prone to fracture.

How Is Bone Density Measured?

Bone density is most accurately measured by a DEXA scan (Dual-Energy X-ray Absorptiometry). This is a simple, non-invasive, and low-radiation test that evaluates the mineral content of specific bones, usually in the spine and hip.

The results are expressed as a T-score, which compares your bone density to that of a healthy young adult:

• Normal : T-score above −1

• Osteopenia : T-score between −1 and −2.5

• Osteoporosis : T-score of −2.5 or lower

These T-scores help determine your risk for fractures and identify whether you’re experiencing early or advanced bone loss.

What Is Osteopenia?

Osteopenia is a condition characterised by lower-than-normal bone density, but not low enough to be classified as osteoporosis. It is often a precursor to osteoporosis and a key warning sign that bones are beginning to weaken.

Symptoms of Osteopenia

• Usually no obvious symptoms

• Occasionally mild bone pain or discomfort

• Gradual loss of height or slight changes in posture

• Increased risk of fractures, especially after minor falls or trauma

According to the World Health Organization (WHO), osteopenia is officially defined by a DEXA scan T-score between −1 and −2.5.

In Australia, the scope of osteopenia is significant. A 2023 report by Healthy Bones Australia found that over 6.2 million Australians aged 50 and over are estimated to have either osteopenia or osteoporosis, that’s around two-thirds of this age group.

What Is Osteoporosis?

Osteoporosis is a more advanced condition of bone loss. It occurs when bone density drops significantly, making bones extremely porous, fragile, and at a high risk of spontaneous or low-impact fractures.

Unlike osteopenia, osteoporosis is not just a warning sign, it is a diagnosis of compromised bone strength that often comes to attention after a fracture has occurred.

Symptoms and Consequences of Osteoporosis

• Fractures – Especially of the hip, spine, wrist, or ribs. These can occur from minor falls or even simple movements like bending or coughing.

• Loss of height – Often due to compression fractures in the spine.

• Stooped posture – Known as kyphosis or dowager’s hump.

• Chronic back or bone pain

• Reduced mobility and independence

• Slow recovery from injuries, particularly in older adults

Osteoporosis is sometimes called a “silent disease” because bone loss can occur without pain or other symptoms until a fracture occurs.

Diagnosis

Osteoporosis is diagnosed with a DEXA scan showing a T-score of −2.5 or below. At this point, bones are considered dangerously weak.

In Australia, the burden of osteoporosis is substantial:

• An estimated 853,600 Australians self-reported having osteoporosis in 2022 (AIHW).

• In 2023, there were approximately 193,000 fractures attributed to poor bone health, about one fracture every 2.7 minutes (Healthy Bones Australia).

• The economic cost of osteoporosis was $4.8 billion in 2023, projected to rise to $8.3 billion by 2033 due to an ageing population and under-diagnosis.

The Royal Australian College of General Practitioners (RACGP) reports that osteoporosis is often under-diagnosed and under-treated, even after someone has experienced a fracture (RACGP).

Shared Causes of Osteopenia and Osteoporosis

Both conditions arise from factors that reduce bone formation, increase bone loss, or both. Common underlying causes include:

• Ageing – Bone mass naturally declines with age, especially after 50.

• Hormonal changes – Hormonal changes are a major contributor to both osteopenia and osteoporosis. In women, the sharp decline in oestrogen after menopause disrupts the natural balance between bone breakdown and formation, leading to accelerated bone loss. Oestrogen is vital for maintaining bone density, and without it, bones become more porous and fragile. In men, testosterone plays a similar protective role, but its decline is more gradual. As testosterone levels fall with age, bone formation slows, increasing the risk of reduced bone density over time. While postmenopausal women are most at risk, older men with low testosterone or chronic health issues can also develop osteopenia or osteoporosis.

• Nutrient deficiencies – Especially calcium, vitamin D, magnesium, and vitamin K2.

• Sedentary lifestyle – Lack of weight-bearing or resistance exercise weakens bones.

• Genetic predisposition – Family history, thin body type, and being of Caucasian or Asian descent.

• Certain medical conditions and chronic illnesses – They can significantly impact bone health by interfering with nutrient absorption or disrupting bone metabolism. Conditions such as Coeliac disease and inflammatory bowel disease can impair the absorption of key nutrients like calcium, vitamin D, and magnesium, essential for maintaining strong bones. Additionally, chronic inflammation and autoimmune diseases, along with endocrine disorders involving the thyroid, adrenal, or parathyroid glands, can alter hormonal balance and increase bone loss over time.

• Certain medications – Especially corticosteroids (like prednisone), proton pump inhibitors (PPIs), anticonvulsants, and aromatase inhibitors.

• Smoking and excessive alcohol consumption – Both negatively affect bone health.

• Low body weight or chronic dieting – Lower oestrogen and reduced mechanical load on bones.

Shared Foundational Treatment Strategies

The treatment strategies for osteopenia and osteoporosis are similar in foundation because they share the same causes but they differ in intensity, urgency, and therapeutic options depending on the degree of bone loss and fracture risk.

Both osteopenia and osteoporosis benefit from:

• Dietary support : Nutrient-rich whole foods high in calcium, vitamin D, magnesium, boron, manganese, zinc and vitamin K2

• Weight-bearing & resistance exercise : To stimulate bone formation and improve balance

• Sunlight exposure : For natural vitamin D synthesis

• Addressing underlying causes : Such as gut issues, hormonal imbalances, or medication side effects

• Lifestyle changes : Reducing alcohol, quitting smoking, managing stress

• Supplements : Tailored to individual needs, often including calcium, D3, K2, magnesium

• Monitoring : Repeat DEXA scans every 1–2 years depending on risk

If you suspect a vitamin or mineral deficiency it is essential to seek medical evaluation for proper diagnosis and management. A holistic healthcare professional such as a naturopath, nutritionist or integrative GP can refer you to have the necessary tests and recommend appropriate interventions to address the underlying cause and improve nutrient levels.

Not All Supplements Are Created Equal 

It’s important to remember that the form, absorption rate, and quality can vary significantly between brands and types. Consulting with a qualified professional, such as a practitioner or holistic healthcare provider, ensures that you’re selecting the most absorbable and highest quality supplements for your individual needs. They can help assess your constitution, allergies, intolerances, sensitivities, age, gender, and any medical conditions or symptoms. A professional also considers potential drug interactions and supplement ratios that may be needed based on your unique health profile. Whether it’s over-the-counter or prescription-grade supplements, the quality, effectiveness, and cost can vary widely, making it essential to have expert guidance for the best outcomes.

Pharmaceutical Treatments

• In osteopenia, pharmaceuticals like bisphosphonates or hormone therapy are typically reserved for high-risk patients (e.g. T-score close to −2.5 plus additional risk factors like smoking or family history of fracture).

• In osteoporosis, especially after a fragility fracture, medication is often strongly recommended. This may include:

  • Bisphosphonates – Slow bone loss by inhibiting the cells that break down bone (osteoclasts), helping to maintain or increase bone density.

    • Common medications :

      • Alendronate – Fosamax, Binosto

      • Risedronate – Actonel, Actonel Combi

      • Zoledronic acid – Aclasta (IV infusion, usually yearly)

  • Denosumab – A monoclonal antibody that blocks bone resorption by targeting a protein involved in osteoclast activation.

    • Common medication : Denosumab – Prolia (subcutaneous injection every 6 months)

  • Teriparatide – A synthetic form of parathyroid hormone that stimulates new bone formation by activating bone-building cells (osteoblasts). Available in Australia via specialist prescription under PBS for severe osteoporosis

    • Common medication : Teriparatide – Forsteo

  • Hormone therapy (HRT) or Selective Oestrogen Receptor Modulators (SERMs) – Replaces or mimics oestrogen to slow bone loss in postmenopausal women.

  • Newer anabolic bone agents – Medications like Romosozumab that both increase bone formation and decrease bone resorption for rapid bone rebuilding. Monthly injection for 12 months, PBS-listed for high-risk patients.

Ready to Treat the Root Cause? 

Osteopenia means it’s time to strengthen bones and prevent further loss. Osteoporosis requires urgent action to prevent fractures and rebuild what’s been lost.

The foundations of care are similar, but the stakes are higher with osteoporosis especially if T-scores are very low or fractures have already occurred. In these cases, a more targeted and timely approach is essential.

Whether you've just been diagnosed, are concerned about your bone health, or have tried treatments without lasting success, a functional, whole-person approach can shift the trajectory of your health, starting now.

Book a naturopathic consultation today and begin a truly holistic, evidence-based plan to restore balance, vitality, and long-term resilience.

This guide is for educational purposes and does not replace medical advice. Always speak with your healthcare provider before making changes to medication or treatment plans.