Most women associate menopause with hot flushes, sleep disturbance, and mood changes. But one of the most significant — and least discussed — consequences of the menopause transition is what happens to your bones. Oestrogen plays a critical role in maintaining bone density, and when levels decline, bone loss accelerates. Osteoporosis affects one in three women over 50 in the United Kingdom, yet it is often not discussed until a fracture occurs.
The good news is that bone loss is not inevitable. With the right assessment, timely treatment, and targeted lifestyle changes, you can protect your bones for decades to come.
How does menopause affect bone health?
Oestrogen supports the activity of osteoblasts — the cells responsible for building new bone. When oestrogen levels fall during perimenopause and menopause, the balance between bone formation and bone resorption tips in favour of loss. Women can lose up to 20 per cent of their bone density in the five to seven years following menopause.
Certain factors increase your risk further:
- Family history of osteoporosis or hip fracture
- Early menopause (before 45) or premature ovarian insufficiency
- Low body weight or BMI
- Smoking or excessive alcohol intake
- Prolonged use of corticosteroids
- A sedentary lifestyle with limited weight-bearing activity
- Conditions affecting nutrient absorption (coeliac disease, inflammatory bowel disease)
The role of HRT in bone protection
Hormone replacement therapy (HRT) is the most effective treatment for preventing menopausal bone loss. Current guidance from the British Menopause Society and NICE supports the use of HRT for osteoporosis prevention in women at increased risk, particularly when started within ten years of menopause onset.
Body-identical HRT — which uses hormones structurally identical to those produced by the ovaries — is well-tolerated by most women and offers benefits that extend beyond bone health: cardiovascular protection, improved mood and sleep, and a better quality of life overall.
The key is early assessment and an individualised approach. HRT is most effective when started during the perimenopause or early postmenopause, before significant bone loss has occurred.
Beyond HRT — lifestyle strategies that matter
Whether or not you take HRT, the following lifestyle factors make a meaningful difference to bone health:
- Strength and resistance training: This is the single most important exercise for bones. Aim for two to three sessions per week focusing on load-bearing exercises such as squats, lunges, deadlifts, and resistance band work
- Weight-bearing cardiovascular exercise: Walking, jogging, dancing, and stair-climbing all stimulate bone maintenance. Swimming and cycling, while excellent for fitness, do not load the skeleton in the same way
- Calcium: Aim for 700 to 1,200 mg daily, ideally through diet — dairy products, leafy green vegetables, fortified plant milks, almonds, and tinned fish with bones
- Vitamin D: Essential for calcium absorption. Supplementation is recommended for most UK residents, particularly during the autumn and winter months. A dose of 1,000 to 2,000 IU daily is generally appropriate
- Protein: Adequate protein intake supports muscle mass, which in turn protects bones and reduces fall risk
- Reducing fall risk: Balance exercises such as tai chi or single-leg stands, along with home safety measures and regular vision checks, are especially important for older women
When should you have a DEXA scan?
A DEXA scan measures bone mineral density at the hip and spine and is the gold standard for diagnosing osteoporosis. You should consider a DEXA scan if you are:
- A postmenopausal woman with one or more risk factors for osteoporosis
- A woman who experienced early menopause (before 45) or premature ovarian insufficiency
- Taking or have taken long-term corticosteroids
- Someone who has had a fragility fracture (a break from a minor fall or impact)
Your results are reported as a T-score: a score above −1.0 is normal, between −1.0 and −2.5 indicates osteopenia (reduced bone density), and below −2.5 indicates osteoporosis. The FRAX tool can estimate your ten-year fracture risk based on your T-score and other clinical factors, helping guide treatment decisions.
Osteoporosis is not an inevitable part of ageing. With early assessment, appropriate treatment, and the right lifestyle changes, you can protect your bones — and your independence — for decades to come.
Concerned about your bone health? Book a menopause and bone health assessment to understand your risk and explore your options.
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