Harriet Kelsall was 46 when a simple fall on a run led to her diagnosis with osteopenia, a bone-thinning condition affecting under-50s. The mother-of-two stumbled and hit the pavement hard, grazing her knee and throwing out her left hand to break the fall. Although she could move her fingers, she went home, used an old wrist support, and strapped two fingers together.
"After about two weeks, I realised my hand had gone purple and I thought, this isn't normal," Kelsall said. "I went to the doctor and a scan revealed I'd broken two very small bones in my left hand and one in my wrist." She admitted she was stupid for not seeing a doctor sooner, initially treating the injury as an inconvenience.
After Kelsall told friends about the fall, they encouraged her to undergo a bone density scan. The DEXA scan revealed she had osteopenia, a condition that weakens bones and precedes osteoporosis, or brittle bone disease. Osteopenia affects roughly seven million people in the UK and usually presents no symptoms until a fracture occurs. Left untreated, it can progress to osteoporosis, leaving bones fragile enough to break from a minor fall, a cough, or a sneeze.
Kelsall, a jeweller who is now 55, said she had never heard of osteopenia before and believed osteoporosis affected only older people. "If it wasn't for my friends pushing me to go for the bone density scan, I definitely wouldn't have known I had it," she said. Following her GP's advice, she started hormone replacement therapy (HRT), took high-dose vitamin D supplements, and overhauled her lifestyle.
She now exercises five times a week by combining sessions on a Peloton stationary bike, a weekly run, and weight training, while cutting refined sugar and increasing protein intake. "I understand now that it's all about making sure your muscles can support your bones," Kelsall said. "If I do fall over, hopefully my muscles will help protect them." She added that although she has not had a follow-up scan, she has since tripped and been thrown off a paddleboard without breaking any bones.
Early warning signs and diagnosis in younger adults
While bone loss is strongly linked to ageing, with up to 40 per cent of over-50s estimated to have osteopenia, doctors report seeing a growing number of younger adults diagnosed. Experts describe the condition as an early warning sign where bones are weaker than normal but not yet osteoporotic. Actress Gwyneth Paltrow, now 53, was diagnosed with osteopenia at age 37 after blood tests showed critically low vitamin D levels.
Professor Alex Comninos, consultant endocrinologist and head of the Imperial College Healthcare NHS Trust Endocrine Bone Unit, said he sees a steady stream of under-50s with fragile bones. "Most didn't realise they were at risk until they'd had a fracture," Comninos said. Osteopenia is diagnosed using a DEXA scan, which measures bone mineral density against a healthy adult of the same sex.
Unlike osteoporosis, which often requires medication, osteopenia can frequently be improved through lifestyle changes like resistance exercise and adequate calcium and vitamin D. It does not inevitably progress to osteoporosis, with risk depending on age, sex, genetics, hormone levels, lifestyle, and underlying medical conditions.
Dr Richie Abel, associate professor of musculoskeletal sciences at Imperial College London, said osteopenia should be viewed as a totally preventable and treatable disease. "A lot of people view osteopenia and osteoporosis as inevitable conditions that happen as a normal part of ageing," Abel said. He noted that peak bone mass is reached between ages 25 and 30, leading scientists to view osteoporosis as a childhood disease rather than one of old age.
"When you're young, you build, grow and develop the bones in your body," Abel said. "If you eat well, exercise regularly and have no nasty diseases or treatments, you should be able to build solid, healthy bones." He warned that failing to build bone mass when young leaves less to lose later in life, increasing fracture risks, though only those with serious fractures are routinely scanned.
Lifestyle factors driving bone loss
Low levels of vitamin D and calcium are among the primary drivers of early osteopenia. Sunlight is the body's main source of vitamin D, which helps absorb calcium to build strong bones. Young people spending more time indoors and being less active risk failing to build a strong skeleton, while obesity can trap vitamin D in body fat.
Smoking and heavy drinking also accelerate bone loss. Smoking lowers protective oestrogen levels and interferes with mineral absorption, while excessive alcohol disrupts bone formation. Low oestrogen is another major factor, naturally falling after menopause but dropping earlier due to early menopause before age 45 or premature ovarian insufficiency (POI) before age 40.
Oestrogen levels can also be depleted by cancer treatments such as chemotherapy, surgery to remove ovaries, eating disorders, low body weight, or excessive exercise. Professor Comninos regularly treats women in their 20s, 30s, and early 40s suffering low bone density from anorexia, underfueling intense exercise, premature menopause, or POI, often recommending HRT for those with premature drops.
Autoimmune conditions and exercise strategies
Autoimmune conditions like coeliac disease contribute to bone weakness by damaging the small intestine lining, obstructing calcium and vitamin D absorption. Coeliac diagnoses are rising in the UK due to better diagnostics and clinical awareness, with studies showing 70 per cent of new coeliac patients have low bone density.
"If you're given the diagnosis of osteopenia, it's not a reason to panic - it's a wake-up call to think about your bone health," Comninos said. He noted that simple changes to diet, vitamin D, exercise, and hormones or medication can stop progression and improve bone strength.
Kirsty Carne, senior specialist osteoporosis nurse at the Royal Osteoporosis Society, recommended assessing risk using the calculator at thegreatbritishbonecheck.org.uk. "We always recommend avoiding smoking as it can have quite a significant impact on bone health," Carne said. "And while it's absolutely fine to have a drink now and again, excessive alcohol can interfere with bone growth and density."
Exercise is the most effective intervention, with weight-bearing activities like walking, dancing, or jogging and resistance training triggering bone-forming cells. Exercises such as tai chi improve balance to reduce fall risks. "You can start small and find your own way of doing exercise - like joining a dance club or doing salsa classes," Abel said. "If you find something you enjoy, you will keep going with it rather than getting bored and quitting."
Abel stressed that prevention is essential to avoid severe complications. "Prevention is so important as - in the worst case - osteoporosis can lead to life-changing fractures that could put you in a care home when you're older and carry a significant risk of mortality," Abel said. "It is very important that people understand just how damaging osteoporotic fractures are. When the choice is between preventing them or not, the answer is simple."
Rebuilding bone density after early diagnosis
Phoebe Lieling was diagnosed with osteoporosis at age 24 after a bone density DEXA scan revealed severe bone loss. "It was scary. I never saw it coming," Lieling said. "I remember thinking, am I really that fragile?" Her osteoporosis was caused by premature menopause combined with undiagnosed coeliac disease, which she discovered after her periods failed to return when she stopped taking the progesterone-only pill at age 22.
After a year of treatments, blood tests revealed very low oestrogen levels. "I was told to be careful not to fall or even be knocked over in case I broke a bone," Lieling said. "But instead of seeing it as a death sentence, I decided to treat it as a challenge."
Prescribed HRT, Lieling transformed her diet and lifestyle, taking supplements and incorporating strength training. By age 30, follow-up DEXA scans showed her bone density had returned to the normal range. Now 36 and working as a nutritional therapist in London, she encourages clients to obtain calcium from dairy products and prioritize strength training that places healthy stress on the skeleton.
