Osteopenia: Questions and advice?

Hi there.

I'm 38 and was referred for a bone density scan because I haven't had a period in four years—even though all my hormone levels come back normal.

My first scan two years ago showed everything was fine.
Last week, I went back for another one, and here are the results:

The T-score for L1/L4 is +0.53. This indicates normal density in the lumbar spine, though the report notes this might be unreliable due to significant degenerative changes; essentially, the BMD values in this area are likely falsely inflated.
The T-score for the hip is -0.77, and the femoral neck is -1.34. The findings for the left hip suggest osteopenia.

Has anyone else dealt with something similar? (As a side note, my mother had total hip replacements on both sides due to osteoarthritis.)

Try taking 40mg of UC II undenatured collagen once a day—though the body only actually absorbs about 10mg. It’s super important that it’s type two undenatured... I've honestly tried everything else, and this is the only thing that actually works for me. Pair it with some MSM and glucosamine, too. That should really help.

Cartilage regeneration is a slow process, but it definitely happens. My joints feel so much better now...

So, which specific hormones are actually looking normal right now? 🤷

Is the prolactin level okay? 🤔

And what about those headaches? 🤔

Have you had an MRI of the brain specifically looking at the pituitary gland? 🤔

All my hormone levels are coming back perfect: LH, FSH, estradiol, testosterone, SHBG, prolactin, AMH, cortisol, thyroid... everything. My doctor tells me my numbers look like a 25-year-old's, not a 38-year-old's. I’ve been cycling through doctors for four years now, and they all tell me I’m a complete medical mystery.

My TSH was slightly elevated about ten months ago, but according to my most recent labs from last month, even that is normal.
No headaches.

I suspect the root cause is a combination of my amenorrhea and a low BMI—it usually hovers between 18 and 18.5, though it was down to 16 when my cycle first stopped. On top of that, there's a genetic predisposition on my mother's side. My gynecologist insisted my cycle would return once I gained weight, but nothing has changed (not that anyone listens when I point out that even my current BMI is low; they just insist I'm not underweight right now).

I want to know if anyone has experience with whether this can be fixed through intentional weight gain, specific exercises, and diet. (It might sound ridiculous to some, but gaining weight is incredibly difficult for me; I already force myself to eat even when I'm not hungry just to maintain my current weight, and any bit of stress sends the pounds plummeting).

The diagnosis is a hard pill to swallow. I'm an active person who works out regularly, and now I'm actually afraid to move. 😢

Looking at the BMI numbers you’re "surrounded" by, it’s actually totally plausible that body mass is an issue for you.
The thing is, you didn't mention your body fat percentage alongside that low BMI, which is honestly way more important than the number on the scale.

I'm trying to keep this as simple as possible.

For female hormones to function the way they should, your body fat percentage is absolutely critical.
Basically, if you don't have enough fat mass relative to your total weight, your body won't trigger the right hormonal activation—even if you go in for bloodwork and everything looks like it's within the "normal" range.

By the way, BMI isn't exactly a precision tool. If you look at certain athletes who sit in that "healthy" 24-26 range, but it's mostly just muscle and bone with almost zero fat, that's a recipe for amenorrhea.
Once the season ends, or the championships wrap up, their body fat goes up, their diet shifts, their training changes, and suddenly the shareholders at Depend and Always are seeing a nice little bump in profits.😁

You didn't mention what kind of activity you're doing, did you?
What does your typical diet look like?
And how are your calories looking, both in terms of total intake and how you distribute them?

With all due respect to my colleagues in the field, if I were your attending physician, once we stepped on the scale and calculated your actual body fat percentage based on your labs, most likely I would recommend:

a) a fundamental overhaul of your eating habits
b) a shift in your exercise routine

As for option A, I'd probably suggest adding at least half a liter of beer 🙂 into your daily routine (ideally a decent craft brew, though not strictly required)—assuming, of course, you don't have any medical reasons to avoid it.

So yeah, I'm pretty much backing up exactly what your gynecologist told you.👍

I really appreciate all the effort and the advice you've given me.

Yeah, my body fat is definitely too low—my last reading was at 10%.

My workouts are a bit of everything: yoga, weight training, spinning, and low-impact cardio. I had a knee injury a few years back, so I have to avoid high-impact stuff now. I stay pretty active, averaging about an hour and a half every day.

As for food, I eat quite a variety, though I avoid most meat because it doesn't sit well with me. I'll stick to what works, though: fats, bacon, or maybe some beef liver. I'm also lactose intolerant, so I can only handle sheep or goat dairy; regular cow's milk just doesn't work for me.
In terms of calories, I aim for around 2,000 a day, usually split into five or six smaller meals.

Is there any alternative for those half-liters of beer? Honestly, I can't imagine my day without it.😉