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The relationship between weight gain, resumption of normal menstrual function and improvements in bone mineral density (BMD) is well-established, but we’re not talking about it enough. 


Low BMD is associated with increased risk for bone stress injuries, such as stress fractures. Low energy availability, disordered eating and clinical eating disorders are associated with low BMD. 


My struggle with anorexia and orthorexia began around age 15, when I started running faster and eating less. Everything was going well - I continued to run faster and faster - until my first stress fracture at age 17, my senior year of high school. 


At age 20 I was diagnosed with osteoporosis after my 4th stress fracture in 3 years prompted a DXA scan - a test usually reserved for females over age 50. 


It should be noted that at the age of 18, I had not yet had my first menstrual cycle so I was put on oral contraceptives with the aim of initiating “normal” periods. But even after 2 years of having (pharmacologically-induced) periods, my bone density was still extremely low. The medication may have created a false sense of normalcy and contributed to further damage rather than addressing the root causes - the eating disorder & unhealthy weight.


It wasn’t until I gained weight that there were improvements in BMD & subsequent decreases in fracture risk.


I went through intensive outpatient treatment in 2010, which initiated my recovery journey. I gained 30 pounds before my next DXA in 2012, which showed significant improvements in BMD that moved me from a classification of osteoporosis to osteopenia (yay!)


By 2020, I had gained another 10-15 pounds and my DXA had improved further, into the NORMAL category (woohoo!!). Even more exciting, my most recent scan a few months ago showed even further increases in bone density - between ages 29 & 32 - so it IS possible to improve bone health even as we enter our 30s!


The point is, weight gain is not a bad thing. It may actually be necessary to resume normal menstrual function and prevent further loss of bone density:


  • Studies of amenorrheic female athletes who gain weight & resume menses show significant improvements in bone health.


  • Percentage weight gain was the strongest predictor of the resumption of menses in a study of female collegiate athletes.


  • Risk factors such as subclinical eating disorders, weight loss and menstrual dysfunction may have a significant negative impact on BMD in young, healthy females.


  • The resumption of normal menstrual cycles and weight gain are crucial for improvements in bone mineral density. 


  • Pharmacologic treatment to restore menses doesn’t address underlying issues and likely won’t result in improved bone health.


So in a world where we’re inundated with messages to be smaller, it bears repeating: Weight gain is not a bad thing. 

If you're looking for a coach or physical therapist who is familiar with stress fractures, bone density issues and eating disorders, let's chat - schedule a phone consult below!




Arends, J. C., Cheung, M. Y. C., Barrack, M. T., & Nattiv, A. (2012). Restoration of menses with nonpharmacologic therapy in college athletes with menstrual disturbances: a 5-year retrospective study. International journal of sport nutrition and exercise metabolism, 22(2), 98-108.

Nieves, J. W., Ruffing, J. A., Zion, M., Tendy, S., Yavorek, T., Lindsay, R., & Cosman, F. (2016). Eating disorders, menstrual dysfunction, weight change and DMPA use predict bone density change in college-aged women. Bone, 84, 113-119.


Iketani, T., Kiriike, N., Nakanishi, S., & Nakasuji, T. (1995). Effects of weight gain and resumption of menses on reduced bone density in patients with anorexia nervosa. Biological Psychiatry, 37(8), 521-527.

Misra, M., Prabhakaran, R., Miller, K. K., Goldstein, M. A., Mickley, D., Clauss, L., ... & Klibanski, A. (2008). Weight gain and restoration of menses as predictors of bone mineral density change in adolescent girls with anorexia nervosa-1. The Journal of Clinical Endocrinology & Metabolism, 93(4), 1231-1237.

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