Since being diagnosed in November, days before Thanksgiving, I have taken a chalky white pill with a full glass of water every Thursday morning, on an empty stomach. Then I have stood or sat upright for an hour before enjoying my customary coffee with microwaved milk, so the medicine can be absorbed and won’t irritate the esophagus (my “food pipe”).

Initially, I was angry:

• At a healthcare system that didn’t warn me years ago that bone density could be an issue for a woman who is white, thin, of northern European heritage, with a small frame and a mother who took Fosomax herself for years.
• At a nurse practitioner who had seen me before my 65^th birthday in July and never mentioned it was time for another bone density scan. I discovered that on my own while clicking through MyChart months later to verify an appointment and saw a notice that my scan was “overdue.”
• At a culture that pressured women to be model thin when I was young. Twiggy was a skinny, 16-year-old kid when the media started marketing her as the ideal body type for women. Even Gloria Steinem, for all her intellect and accomplishments, became the face of the 1970s-era women’s movement in part because she, too, was thin and pretty.

“I have to focus more on being strong than being thin,” I wrote on Facebook shortly after my diagnosis of thinning bones. Enough crowing about keeping a closet full of clothes from my 40s and 50s “because they still fit.” Or celebrating that I weigh less than I did when I got pregnant with my older son, who was born in 1990. Or preferencing cardio exercise, which gives me an emotional lift, over the tougher, more monotonous work of lifting weights.

One of my sisters was nurturing and supportive, texting or calling to offer tips about the benefits of Pilates or which calcium-rich foods to eat. (Who knew that ice cream, eggnog and fortified frozen waffles would make the list, alongside kale and broccoli?)

My oldest sister, the pragmatic one, issued a simple challenge: What are you going to do about it?

Name it, claim it

The word itself scares me. Osteoporosis conjures up images of an old, wizened woman whose upper back has curved into a question mark. My reluctance to name the disease, to say the word aloud, is both a symbol and a symptom of my denial. Just as I resisted the label alcoholic when I recognized in my early 40s that I needed to quit drinking, I now reference my “bone density issue.”

Osteoporosis is for old people; osteoporosis, like forgetfulness and a thickening middle, is for my late mother. Thinning bones don’t afflict people who are fit and who exercise as much as I do.

Or so I thought. Physically active throughout my life — a seasoned cyclist, a walker who averages 16,000 steps a day, a former aerobics instructor who still loves to take yoga classes — I was stunned that thinning bones could be a problem. When the nurse practitioner handed me a printout from Mayo Clinic at my follow-up appointment, I noted that none of the “lifestyle choices” that increase risk of osteoporosis apply to me:

1. Sedentary lifestyle. I have a hard time sitting still. “You’re in fifth gear or asleep,” my husband likes to say.
2. Excessive alcohol consumption. I haven’t had a drink since January 10, 2010.
3. Tobacco use. I never could inhale.

“This is not your fault,” the nurse practitioner assured me after I told her I was scared. But the diagnosis, especially on the cusp of snow and ice season in Minnesota, felt like a slippery slide into old age — like “being suddenly Old and Fragile,” as one friend aptly put it.

How would I walk my dogs every morning when falling could more easily break my bones? Would I have to abandon biking come spring, a sport I have loved since I was 5, because a tumble could sideline me forever? Exercise and movement are my sanity, my way of coping with stress, my increasingly tenuous hold on independence, my illusion that I will be forever young.

As the shock has worn off, I have moved gradually toward acceptance, and into action. Do something now, or you’ll pay later. That much is clear.

Bone up

Watching my weight was something I could control in a world that (still) tries to control women’s bodies. Now, I apply that discipline to self-care for my bones.

One lesson I’ve learned already is to take charge of my own healthcare. In a system still exhausted and under-resourced from COVID, no doctor is going to walk me through this. Doing my own research and seeking support from friends and family members, including my weight-lifting sons, have pulled me out of the muck of fear and self-pity.

• Thursday is Fosomax day, with a weekly reminder on my calendar. The hour of being upright and foregoing any nourishment but water is peaceful and productive quiet time.
• I lift free weights two to three times a week and am relishing growing stronger.
• I have started taking a Pilates Fusion class designed for people with arthritis and osteoporosis, with special emphasis on strengthening back, glute and abdominal muscles.
• I no longer skip my daily calcium and Vitamin D3 supplements.

That my diagnosis came on the cusp of a major life change — a step away from a full-time career, and all the status and identity and financial security that brought me — has made osteoporosis seem both an indignity and oddly well timed, a gentle push into the next phase of life and a firm reminder to accept reality and deal with it.

“Everyone hopes to reach old age, but when it comes, most of us complain about it,” the Roman philosopher Cicero said. Had I not been searching the website for tips on healthy bones, I never would have stumbled upon “Lessons on Successful Aging,” derived from Cicero’s 2,000-year-old essay “On Old Age.”

Among the lessons relative to women at this later stage of life:

1. A good old age begins in youth. I can wish that I had started lifting weights at a younger age, but I cannot change the habits or negligence of the past. All I can do is develop new patterns now.
2. We can be active in old age, with limitations. Winter biking will never be a sport I’ll pursue, just as jogging outdoors in winter now seems foolhardy.
3. Youth and old age differ. Longing for what was keeps us stuck in the past and blocks us from embracing the benefits of aging.

Osteoporosis, the Big O for older women, is my necessary reminder that good health is neither a given nor guaranteed.