What You Need to Know About Menopause and Osteoporosis

What is bone density?

Bone density is the amount of minerals — mainly calcium and phosphorus — inside your bones. These minerals give your bones strength and structure. You might also hear it called bone mineral density and bone mass.

Even though we don't always think of them this way, bones are living cells and tissues. They're constantly going through a natural process of breaking down old cells and building new bone.

When we're younger, the body makes new bone faster than it removes old bone. But after age 50, this balance shifts. We start losing bone more quickly than we can make new bone and replace it.

As bone density (the amount of calcium and phosphorous) decreases, the outer walls of the bone get thinner, and the honeycomb-like center develops larger spaces. This makes bones weaker and increases the chances of breaking a bone from something as simple as a fall or bump.

This natural change can happen slowly and more quickly depending on your risk factors, including family history, body size, lifestyle habits, and hormone levels. 

Bone density naturally declines with age, but understanding it can help you take steps towards increasing bone strength and preventing bone loss in the long term.

What is osteoporosis?

Osteopenia and osteoporosis both refer to low bone density. Osteopenia is mild bone loss. Osteoporosis is more advanced bone loss, meaning bones are weaker and more likely to fracture. A bone density test, usually a DEXA scan which uses low-dose x-rays, can help diagnose both conditions.

The biggest concern with osteoporosis is the possibility of fractures. These often happen in the spine, wrist, or hip because they have lower bone density. Hip fractures, in particular, can have long-term effects on mobility, independence, and overall health. Many don't notice symptoms until a fracture occurs, which is why screening is so important. 

You can receive treatment for osteoporosis and the earlier it’s given, the more likely you are to respond to it.

Several risk factors increase the likelihood of osteoporosis: aging, a family history of fractures, smoking, low calcium and vitamin D intake, and certain medications. Hormonal changes during menopause play an especially big role.

What’s the relationship between menopause and osteoporosis?

Menopause is the most common cause of osteoporosis. During the menopausal transition, estrogen levels drop. Estrogen helps protect bone by slowing down natural breakdown, so when estrogen levels fall, bone loss speeds up. Up to 20% of total bone loss can occur during this transition.

While many people think first about menopause symptoms like hot flashes and mood changes, what's happening inside your bones is just as important. These hormonal shifts can cause you to develop osteoporosis more quickly in your 50s and early 60s.

Because estrogen plays a direct role in maintaining bone health, females experience higher rates of osteoporosis and related fractures than males. Paying attention to bone health early can help prevent fractures and slow changes over time.

What can I do to slow down bone loss?

• Get regular physical activity. Resistance and weight-bearing exercises can help build and strengthen bones. Strength training, walking, hiking, jogging, climbing stairs, tennis, and dancing are all good examples. Staying active also improves balance and coordination, which can reduce the risk of falling and breaking a bone.
• Eat foods that support bone health. Protein, calcium, and vitamin D are important nutrients to include daily. These nutrients work together to build and maintain bone. Dairy, leafy greens, and fish are great options. Ask your doctor whether supplements might help support you long term.
• Quit smoking. Smoking increases the risk of weakened bones and potential fractures. If you’re struggling to quit, reach out to your doctor or call 1-800-QUIT-NOW for helpful resources.
• Limit alcohol consumption. Drinking too much alcohol can speed up bone loss. Limiting your intake, or avoiding alcohol altogether, can help protect your bones.
• Medications. Your doctor may recommend starting a medication for treatment of osteoporosis that slow the breakdown of bone or help rebuild bone. These medications can include bisphosphonates or anabolic agents (teriparatide, abaloparatide, romosozumab).
• Menopause hormone therapy (MHT). Although MHT is not one of the first medications recommended to treat osteoporosis, estrogen can decrease the risk of fractures and support those who are also managing common menopause symptoms like hot flashes. Your provider can help you weigh the benefits and risks.
• Know your risk factors. Everyone's bone health story is different. Understanding your personal risk, such as early menopause, family history, past fractures, or low body weight, can help you and your doctor build a plan focused on preventing bone loss and preventing fractures as you age.