Bone health is one of the main health concerns that affects people in later life. While bone mass naturally decreases over time, it’s particularly accelerated during menopause, leaving women significantly more at risk of developing osteoporosis than men.
Research suggests women can lose up to 20% of bone mass in the years during and after menopause, and approximately one in 10 women over the age of 60 has osteoporosis worldwide.
Beyond the physical symptoms – an increased risk of fractures and falls – osteoporosis can also take a toll on mental health, affecting confidence, independence, and quality of life. This is why taking steps to boost your bone health is one of the best things you can do to protect your long-term wellbeing.
The good news is that making healthy lifestyle adjustments can make a meaningful difference, and hormone replacement therapy (HRT) is also considered an effective treatment option for many women.
Here, we’ll take a closer look at the link between menopause and bone health, exploring its impact on the mind and body, and what you can do to protect yourself.
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What’s the link between menopause and bone health?
It’s natural for bone mass to decrease with age. Research shows that, generally, after age 35, the rate at which bone is broken down begins to outpace the speed at which new bone is formed – although this can vary from person to person.
Loss of bone mass increases the risk of osteoporosis (brittle bones), a condition that causes bones to become weak, fragile, and prone to fracture.
While factors like family history, smoking, drinking alcohol, and not getting enough calcium and vitamin D (which the body relies on to grow new bone tissue) can all play a role in the development of osteoporosis, menopause is considered the main risk factor. According to statistics, almost 80% of people diagnosed with osteoporosis in the UK are women, and one in three women over 50 worldwide will experience osteoporosis-related fractures.
This is because during the menopause journey, levels of hormones like oestrogen and progesterone begin to decline. Among other things, oestrogen helps protect against cells that break down bone (osteoclasts), meaning women are breaking down more bone than they can make to replace it.
Early menopause (before 45, and especially before 40), as well as premature ovarian insufficiency (POI) and removal of the ovaries, can all further contribute to osteoporosis risk because the body is without sufficient levels of oestrogen for longer.
Note: While osteoporosis is more prominent among women, men are also affected. According to the Royal Osteoporosis Society, around 20% of men over 50 experience osteoporosis-related fractures. However, because men tend to have larger bones, this can place them at a lower risk of fractures.
Why is it important to prioritise bone health?
Over three and a half million people in the UK are living with osteoporosis, and its impact can extend far beyond the bones.
Central to this is the heightened risk of fractures, which can occur even from relatively minor bumps and falls. A hip or knee fracture, for example, can be life-altering –causing persistent pain, limiting mobility, and reducing independence.
Studies show that around 60% of people struggle with daily tasks, like bathing and dressing, in the aftermath of a fragility fracture. Once a first fracture has occurred, a person is also five times more likely to experience a second fracture within the following two years. And for many people, the pain, social isolation, and fear of falling linked to poor bone health and fragility fractures can lead to struggles with anxiety and depression.
Other research has linked osteoporosis-related fractures with premature mortality, including a mortality rate of up to 22% within one year of a fracture. While fractures are rarely the direct cause of death, researchers suggest they often act as ‘trigger events’ that exacerbate underlying chronic conditions, increasing the risk of things like blood clots, infection, pneumonia, surgical stress, and loss of mobility.
In light of this, experts have compared the number of fracture-related deaths in the UK to that of many chronic diseases, including diabetes, lung cancer, and chronic respiratory diseases.
Yet, because osteoporosis often develops slowly without symptoms, many people aren’t aware they have it until a fall or impact causes a fracture. It’s frequently referred to as the ‘silent disease’, meaning many of us forget to prioritise our bone health until issues arise. However, taking steps to improve your bone health is one of the best things you can do for your long-term health.
3 ways to take care of your bone health during menopause
While some osteoporosis risk factors like menopause are out of our control, there are still steps you can take to reduce the impact of bone loss on your health. We’ll cover some of these below.
For a more in-depth guide, check out our article: 9 ways to improve bone health.
1. Focus on strength training and weight-bearing exercises
Bones are made of living tissue, and the more we use them, the stronger they get. Staying active also helps our joints, muscles, and ligaments stay strong, which can reduce the risk of falls and fractures.
The NHS advises adults to do 150 minutes of moderate-intensity exercise every week, which can include anything from dance and power walking to water aerobics. However, research has found that certain forms of exercise, specifically strength training and weight-bearing exercises, like jogging, may be particularly beneficial for keeping bones strong.
In this study, long-term distance running was associated with healthier bones, particularly among older runners. And another study highlighted progressive squat training, even at low intensities, as an effective solution for improving bone health and reducing fracture risk.
To learn more, check out our guide: Staying active with osteoporosis – 6 simple exercises to strengthen bones.
2. Prioritise bone-boosting nutrients
Bones go through a constant process of being broken down and replaced by new cells. So, it’s important to make sure you’re getting enough bone-building nutrients – namely, calcium and vitamin D. Among other things, calcium is an essential building block for bones, and vitamin D helps our bodies absorb and store calcium.
Some of the best sources of calcium include cow’s milk, cheddar cheese, and leafy greens like kale – while sunlight and foods such as eggs, oily fish, lamb liver, and yoghurt are all rich in vitamin D.
While most people are able to get all the calcium and vitamin D they need from a healthy, balanced diet, your doctor may advise taking supplements when osteoporosis risk is higher, including during menopause. The NHS also advises that adults consider taking a daily vitamin D supplement between September and April, when sun exposure is lower.
If you suspect you’re not getting enough calcium and vitamin D, it’s worth speaking to your GP, who’ll be able to advise you on supplements.
Other nutrients important for bone health include protein, B vitamins, potassium, and vitamins C and D. You can find out more about how to incorporate these into your diet in our article: 12 of the best foods for bone health.
3. Take steps to cut down on alcohol and quit smoking
We know from research that unhealthy lifestyle habits like smoking and drinking alcohol can negatively affect bone health. So, making healthy adjustments can help reduce your risk of developing issues.
For example, studies have linked smoking and drinking with accelerated bone loss and higher osteoporosis risk, partially due to their interference with the absorption of nutrients like calcium and vitamin D.
For help getting started, check out our guides to quitting smoking and staying alcohol-free.
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What about hormone replacement therapy (HRT) for bone health?
Many of the best things we can do for our bone health are rooted in lifestyle habits, like diet and exercise. However, if you’re concerned about your bone health, you may also be considering other options, like HRT.
Hormone replacement therapy (HRT) is a treatment used to help women manage menopause symptoms. It works by replacing the hormones in your body that decline during menopause, including oestrogen and progesterone.
Several studies suggest HRT may help to effectively prevent bone loss and reduce fracture risk. As a result, NICE recommends it as a treatment for osteoporosis in perimenopausal and menopausal women.
For example, estradiol (a type of oestrogen hormone used in HRT) has been found to slow the rate of bone loss and promote the growth of new bone, improving overall bone strength. Meanwhile, progesterone works alongside estradiol to support bone formation and prevent bone loss.
To help you decide whether HRT is right for you, it can be useful to discuss options with your GP. To find out more, check out our article: Hormone replacement therapy (HRT) explained.
Should I have a DEXA scan?
Because of the link between menopause and bone health, it’s normal to feel overwhelmed or on edge at the thought of fracturing a bone. For this reason, many women want to understand more about their current bone health.
A DEXA scan (bone density scan) is a simple, painless scan used to measure bone density. It takes your bone density measurements and compares them with those of people of the same age and gender to indicate whether you’re at risk of, or have already developed osteoporosis.
DEXA scans may be recommended if you have an increased risk of developing a bone problem, like osteoporosis. According to NHS criteria, you may be offered a DEXA scan if you…
- Are a woman who has had early menopause, or have had your ovaries removed at a young age (before 45) and haven’t had hormone replacement therapy (HRT)
- Are a postmenopausal woman who smokes and drinks heavily, has a family history of hip fractures, or a BMI of less than 21
- Have previously broken a bone after a minor fall or injury
- Have a health condition, such as arthritis, that can lead to low bone density
- Have large gaps (of more than a year) between periods
- Have been taking medicines called oral glucocorticoids (used to treat inflammation) for three months or more
In some cases, people may need a DEXA scan to assess whether their risk of breaking a bone is high enough to need treatment. However, DEXA scans are also available at many private clinics to women who are otherwise healthy but just want to know their bone density.
You can find out more about DEXA scans on the NHS website.
Final thoughts…
Menopause is a significant time of transition in every woman’s life. The decline of hormones like oestrogen can result in a range of symptoms and affect almost every area of life, including bone health. Luckily, research shows that lifestyle changes can make all the difference, and HRT is available, too.
For further reading, head over to our menopause section. Here, you’ll find information on managing everything from sleep, brain fog, and hot flushes during menopause.
What symptoms have you experienced during menopause? Do you have any tips that you’d like to share? We’d be interested to hear from you in the comments below.
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