Optimizing Bone Density Before and After Menopause: A Functional Medicine Approach

Written By Tristan Ilingan

INTRODUCTION

Bone health is often discussed in very simple terms: take calcium, exercise regularly, and get a bone density scan. While those recommendations are helpful, the biology of bone is far more complex. Bone is not an inert structure—it is a living, metabolically active tissue that responds to signals from hormones, nutrition, inflammation, and mechanical stress. In fact, many active women who exercise regularly can still experience declining bone density when deeper metabolic factors are overlooked.I recently had the opportunity to present a community lecture on this topic for members of the fitness community at Evoke Fitness.

The goal of this lecture was to move beyond the simplified “calcium and cardio” approach and explore how metabolism, cellular health, and lifestyle factors influence bone strength at every stage of life.

Below is a summary of the key concepts from that lecture.

BONE IS A LIVING TISSUE.

Bone is constantly undergoing a process called remodeling, where old bone is broken down and replaced with new bone.

This process is regulated by three key cell types:

  • Osteoclasts – break down old bone

  • Osteoblasts – build new bone

  • Osteocytes – act as the master regulators

Osteocytes are embedded within the bone matrix and function as mechanosensors, detecting mechanical stress during movement. Research supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases highlights their role in mechanotransduction—the process where physical force is converted into biological signals that stimulate bone formation.

WHAT A DEXA SCAN ACTUALLY TELLS USDEXA

scans measure bone mineral density, typically at the hip and spine.

They are used to diagnose:

  • osteopenia

  • osteoporosis

However, bone strength is not determined by density alone. DEXA scans do not measure:

  • collagen integrity

  • bone microarchitecture

  • inflammation

  • metabolic health

This is why many women can have “normal” scans but still be at risk.

FUNCTIONAL LAB MARKERS THAT MATTER

Lab work often reveals early signs of bone stress years before changes appear on imaging. Key markers include:

  • Vitamin D (25-OH)

  • Ferritin

  • Magnesium

  • Parathyroid Hormone (PTH)

  • Alkaline Phosphatase

One often overlooked marker is albumin, which reflects protein status and plays a role in nutrient transport. Since bone is approximately 50% protein matrix, this is a critical piece of the puzzle.

BONE IS MORE THAN CALCIUM

Bone structure is made up of:

  • 50% protein (collagen matrix)

  • 25% mineral

  • 25% water

The collagen matrix provides flexibility and resilience, while minerals provide hardness. Without adequate protein and nutrient support, bone can become brittle—even when density appears normal.

OXALATES AND MINERAL BALANCE

Certain plant foods contain compounds called oxalates, which can bind minerals like calcium and magnesium. Foods higher in oxalates include:

  • spinach

  • almonds

  • beet greens

  • Swiss chard

These foods can still be part of a healthy diet, but excessive intake without variety may impact mineral absorption in some individuals.

CELL MEMBRANES, SEED OILS, AND METABOLIC HEALTH

Every cell in the body is surrounded by a membrane made of lipids. These membranes regulate:

  • hormone signaling

  • inflammation

  • insulin sensitivity

  • nutrient transport

The fats we consume directly influence the structure of these membranes. Highly processed seed oils—such as soybean, corn, and sunflower oil—are rich in polyunsaturated fats that are vulnerable to oxidation. When these fats oxidize, they may contribute to cellular stress and inflammatory signaling. Because inflammation influences bone remodeling, this connection between dietary fats and metabolic health is important to consider.

PLASMALOGENS AND CELLULAR RESILIENCE

An emerging area of research focuses on plasmalogens, specialized phospholipids that support cell membrane integrity.They are involved in:

  • protecting against oxidative stress

  • supporting mitochondrial function

  • maintaining cellular communication

Plasmalogen levels tend to decline with aging and have been observed to be lower in several chronic disease states.Supporting membrane health may play a role in overall metabolic resilience and tissue repair, including bone.

WHY EXERCISE IS ESSENTIAL FOR BONE HEALTH

Bone is a mechanosensitive tissue, meaning it adapts to the forces placed upon it.When you perform resistance training or impact movements:

  • bones experience small mechanical strain

  • osteocytes detect that strain

  • signals are sent to build stronger bone

Exercises that are most effective include:

  • strength training

  • jumping and plyometrics

  • sprinting

  • resistance-based movement

Muscle contraction plays a major role, as forces generated by muscles often exceed those from gravity alone.

THE FIVE PILLARS OF STRONG BONESA

functional medicine approach to bone health includes:

  1. Mechanical loading through exercise

  2. Nutrient sufficiency and protein intake

  3. Hormonal balance

  4. Healthy cell membranes and metabolism

  5. Recovery, sleep, and stress regulation

FINAL THOUGHT

Bone health is not determined by a single supplement or habit. It reflects the combined influence of:

  • movement

  • nutrition

  • metabolism

  • cellular health

  • recovery

Ultimately, the health of our skeleton reflects the health of our cells—and the signals we send them every day.

Interested in a personalized approach to bone health?

At Vigeo Health, I offer functional medicine nutrition consultations that include:

  • comprehensive lab analysis

  • personalized nutrition strategies

  • targeted supplement and lifestyle protocols

Visit: www.vigeo-health.com

Tristan Ilingan