Screening for osteoporosis is recommended for women 65 years and older and should be considered for younger women who have one or more risk factors for osteoporosis.

The risk factors for osteoporosis and fractures include: 
- Having early menopause
- Having a family history of osteoporosis or a parent with a history of hip fractures
- Having a personal history of fractures 
- Having a history of falls
- Being a thin Caucasian or Asian woman
- A lower weight or body mass index (usually <18.8)
- Poor nutrition
- Smoking cigarettes
- Inadequate physical activity
- Consuming more than three alcoholic drinks a day
- Taking certain medications, including steroids or aromatase inhibitors (for breast cancer)
- Having certain health conditions, including early ovarian failure (before age 40), rheumatoid arthritis, chronic liver disease, inflammatory bowel disease, or a history of hyperthyroidism

Bone density is most often assessed by Dual-Energy X-Ray Absorptiometry (DEXA), which is a simple X-ray test that looks at the hips and spine. No anesthesia is required and the amount of radiation used is extremely low. During the test, you’ll lie fully clothed on a padded platform while an X-ray machine arm passes above you. The test lasts about 10 minutes. 

The results of a bone density test are called a T score. The lower the T score, the greater the risk of fracture. 
- Normal bone density: People with normal bone density have a T score of -1.0 or above
- Low bone density (osteopenia): People with low bone density, or osteopenia, have a T score between -1.0 and -2.5
- Osteoporosis: People with osteoporosis have a T score of -2.5 or below

A large body of recent research shows that if women start hormone replacement therapy within 10 years of their last period, not only do they enjoy significant relief from menopausal symptoms but they also have a lower risk of bone loss (as well as heart disease). HRT causes estrogen levels to increase, which helps prevent bone loss and reduce your chance of breaking a bone or developing osteoporosis.

Certain lifestyle measures can help prevent osteoporosis. These include:
- Getting sufficient calcium and vitamin D. The suggested intake for postmenopausal women is 1200 mg/ day of calcium and 800 IU/day of vitamin D. 
- Doing weight-bearing exercises, such as strength training or aerobic fitness, for 30 minutes three times a week
- Avoiding smoking cigarettes
- Reducing your risk of falls by placing anti-slip material below rugs (or removing rugs altogether), adding grab bars to bathtubs and showers, placing nightlights in rooms, securing electrical cord placement, and having ambulatory assistive devices available, if needed
- Avoiding heavy alcohol intake (more than three alcoholic drinks a day)

Midi is a virtual clinic that provides specialty care for women 40+. In our video visits, you meet with a clinician trained specifically in perimenopause, menopause, and other aspects of female midlife health. We collaborate with you to improve your symptoms with a Care Plan personalized to your medical history, genetics, and approach to health. Midi care is holistic, and may include prescription drugs, supplements and botanical remedies, wellness therapies, and lifestyle coaching. Midi orders any blood work and/or imaging needed to track and treat your unique hormonal transition, and we refer you to your regular doctors or specialists for any necessary in-person care.

Our clinicians are licensed nurse practitioners (NPs), CNMs (nurse midwives), doctors (MDs), and naturopathic doctors (NDs) who specialize in women’s midlife health. In addition to their invaluable clinical experience, they receive intensive training from nationally-recognized experts in perimenopause and menopause. All Midi treatment is overseen by menopause doctors who work closely with clinicians to create a Care Plan personalized to every patient.