“Fear is a wonderful motivator,” says Steven R. Goldstein, MD, a New York–based gynecologist and professor at NYU who has treated menopausal women for decades. “My patients are all really good about their breasts,” he said. “They get their mammograms and ultrasounds every year. I wish everyone were as focused on their bone health.” The statistics are indeed terrifying: 21 percent of older women who fracture a hip die within a year, and 25 percent don’t ever live independently again. Goldstein conceded that these numbers tend to refer to people much older than me, but still I was right to feel dread.
Dread is what finally forced me to start a weight-bearing exercise routine. Dread and the fact that a new outpost of Good Day Pilates opened a half block from my Brooklyn apartment. Founded by Clara Gilmour, a physical therapist, the studio offers classes that incorporate heavy resistance bands and the occasional kettlebell to provide what Gilmour calls, appealingly, a “strengthening dose.” For someone like me, she says, a classical balletic Pilates class with a lot of stretching might not be sufficient. “You want to work the muscles in a way that actually pulls on the bone and stimulates new growth. You need to work to the point of fatigue, where the muscle—and the bone—actually respond.”
So now I go three, sometimes four, days a week. Besides its extreme proximity, I like that the studio has no mirrors and I am able to convince myself that taking a class is a nonnegotiable sort of medicine.
Is it working? I might not know for decades, but wanting a second opinion—or perhaps just reassurance that I wasn’t already halfway to collapsing into a pile of dust—I call David Karpf, MD, an endocrinologist at Stanford who specializes in metabolic bone disease.
“I really wish every woman had a baseline DEXA scan taken before menopause,” he tells me. The test itself, he explains, is an imperfect instrument, especially for people whose bones, like mine, are smaller than average.
“Let’s calculate your fracture risk right now,” he suggests, rattling off a list of rapid-fire questions. What was my height, my weight, my age? When did I start menstruating? Had my mother or father ever fractured a hip? Had I ever broken a bone? I could hear him typing figures into a calculator on the other end of the line.
He reads the results aloud. “You have a 99.2 percent likelihood of not having a hip fracture in the next 10 years.”
What my earlier scan had probably captured, Karpf explains, was simply the natural consequence of having small bones. “In all likelihood, this is a good representation of your peak bone mass,” he said.
It was just one opinion, but I hung up the phone and was tempted, if I’m being honest, to cancel my upcoming Pilates class. But that was not the point. Even if the story my mother told was maybe not quite as inevitable as it sounded, I should do everything in my power to offset this folkloric family hex. So I continue to drag myself to Pilates and swallow a calcium supplement with my coffee. And one day soon I will probably purchase an Osteoboost belt, which will rumble at the base of my spine as I make my way to pick up my daughter at day care, to which I have begun to bring a sippy cup of milk.
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