Bone loss in the menopause: protecting your bone health
Why bone loss speeds up around the menopause, when it peaks, and what the guidelines say about hormone therapy, calcium and vitamin D, resistance exercise and DEXA scanning.
As oestrogen falls in the menopause, the breakdown of bone speeds up and the risk of osteoporosis rises markedly. Bone loss begins around 1 year before the final period and peaks in the first 3-5 years after the menopause — which is why acting early matters so much.
The menopause is a natural stage of a woman's life, and not simply the end of menstrual cycles: many systems in the body are reorganising. One of the things that deserves most attention during it is the risk of osteoporosis, which usually progresses silently.
What is osteoporosis, and why does it accelerate in the menopause?
Bone is living tissue, constantly broken down and rebuilt. In a woman's body, the single most important factor keeping that balance is oestrogen. It preserves bone mass by suppressing the activity of the cells that break bone down (osteoclasts), increases the absorption of calcium from the gut, and keeps the microarchitecture of bone strong.
But in perimenopause — which begins years before periods stop altogether — oestrogen levels start to fluctuate and fall. Current research, the SWAN study among it, shows that bone loss begins to accelerate 1 year before the date of the final period and peaks within the first 3-5 years after the menopause. In that short transition window, women can lose up to an average of 10% of bone mass in the spine and hip.
What can be done to protect bone health?
Bone loss gives no signs until a fracture happens. With current medical approaches, though, it is possible to slow the process and preserve bone mass. The main steps are these.
Hormone therapy and the window of opportunity
According to the guidelines of the International Menopause Society (IMS) and other established authorities, menopausal hormone therapy (MHT) is one of the first-line options for preventing menopause-related bone loss and future fracture risk.
The rule here is not to leave it too late. Starting hormone therapy in early perimenopause, when symptoms begin, or within the first 10 years of the menopause (before the age of 60) is known as the window of opportunity, and it gives the greatest benefit in preventing bone loss. For this purpose, bioidentical hormones — chemically identical to the ones the human body produces, such as transdermal oestradiol applied to the skin and natural micronised progesterone — are now preferred. The guidelines note that doses of 1 mg oral or 50 mcg transdermal oestradiol are generally effective for bone protection.
Eating for calcium and vitamin D
Calcium is the main building block of bone, and vitamin D is what allows it to be absorbed. Adding calcium to your diet does not have to mean relying on milk and dairy alone. Alongside fermented foods such as yoghurt and kefir, sesame, sardines eaten with the bones, spinach, radish tops and beet greens are all substantial sources of calcium. Where diet cannot cover the need, or where vitamin D is deficient, supplements can be planned under medical supervision — together with vitamin K2, which supports calcium going to bone rather than to blood vessels.
Resistance and weight-bearing exercise
Walking is excellent for heart health, but on its own it may not be enough to increase bone density. To stimulate bone mechanically and to preserve muscle mass (guarding against sarcopenia), resistance exercise — weights, resistance bands, or bodyweight work — should be added to the programme on at least two days a week.
Lifestyle choices
Smoking and heavy alcohol consumption are among the main factors that speed up bone breakdown and interfere with oestrogen metabolism. Moving to a Mediterranean-style diet, keeping to a healthy body weight and reducing inflammation protects not only your bones but your heart and blood vessels too.
In conclusion
Osteoporosis is not an inevitable consequence of ageing; it can be prevented and treated. Do not wait for your periods to stop entirely, or for something to start hurting, before looking after your bones. From the beginning of perimenopause you can talk to your gynaecologist about bone density measurement (DEXA) and an assessment of your personal risk factors, and build the follow-up and treatment plan — hormone therapy included — that suits you.
Frequently asked questions
What are the signs of bone loss in the menopause? There are usually none until a fracture occurs; loss of height and back pain are late findings.
When should a bone density (DEXA) scan be done? From perimenopause onwards, alongside a risk assessment.
Can bone loss be reversed? With appropriate treatment and changes to lifestyle, loss can be slowed and bone mass increased to some extent.
Does hormone therapy prevent bone loss? Treatment started within the first 10 years of the menopause is effective in preventing bone loss.
This page is for information. It does not replace an examination or individual medical advice.