Building strength from within: your guide to bone health during menopause

Menopause is often described as a time of change, but one crucial transformation that doesn’t get enough attention is its impact on bone health. Declining oestrogen levels can significantly affect your skeleton, leading to a loss of bone density and an increased risk of osteoporosis and fractures.

Women are affected far more often than men—up to four times as often. One in two women over 50 will suffer an osteoporotic fracture during her lifetime. Hip and spinal fractures, in particular, can result in long-term disability and, in some cases, even premature death. And yet, osteoporosis remains widely underestimated. After all, who imagines a hip fracture at 52? Most of us still think: “That only happens to the very old in care homes.” That misconception delays crucial prevention and diagnosis.

Certain women are especially at risk: If menopause starts before age 45, bone loss begins earlier and continues for longer. Add a family history of osteoporosis or fractures, and the risk increases even more.

The good news? You can take action. With smart lifestyle choices, medical support, and the right information, you can protect your bones for the decades ahead.

Understanding your bone health is the first step to safeguarding it. Diagnostic tools include:

• Bone density scans (DEXA): This is a quick, non-invasive and painless test that uses low-dose X-rays to measure the mineral content of your bones—typically in the spine and hip. The results help determine your risk of fractures and whether you may have osteoporosis.

• Fracture risk assessments: Tools like FRAX or Q-Fracture predict your 10-year risk of major osteoporotic fractures. These tools are especially helpful for women with risk factors such as early menopause, low body weight, or a family history of osteoporosis.

• Blood tests: These check for vitamin D, calcium levels, and markers of bone turnover that can indicate how fast your bones are breaking down and rebuilding.

In Germany, statutory health insurance covers a DEXA scan only under specific circumstances—such as after a low-trauma fracture or with a confirmed osteoporosis diagnosis. Otherwise, the cost must be covered privately, usually between €40 and €80.

Bone health isn’t just about avoiding fractures; it’s about creating a foundation for overall wellbeing. Here’s your toolkit:

• Nutrition:Good nutrition isn’t just fuel for your body—it’s also the building block for strong bones.

  • Calcium: This mineral gives bones their strength and density. Foods like dairy products, leafy greens, almonds, and fortified plant-based milks are great sources. Aim for about 1,200 mg daily. If dietary calcium is insufficient, supplements may be necessary but only the second best choice.

  • Vitamin D3: Essential for calcium absorption, vitamin D3 supports strong bones and muscle function. A daily supplement of 1,000–2,000 IU is recommended, especially during winter months when sunlight exposure is limited. For those with proven deficiency (blood sample) higher doses might be necessary

  • Protein: Bones are not just minerals; they also contain protein. Include lean meats, fish, beans, and nuts in your diet to ensure your bones stay strong and flexible.

  • Prebiotics: A healthy gut supports better calcium absorption. Foods like bananas, garlic, and fermented options like yoghurt or kefir promote good gut health.

• Exercise:Physical activity is one of the best ways to strengthen your bones. Bones respond to the stress placed on them by growing stronger, so regular movement is key.

  • Weight-bearing activities: Walking, jogging, or dancing involve working against gravity, which strengthens your bones.

  • Resistance training (strength training): This form of exercise is particularly effective at improving bone density and preventing fractures. Resistance exercises involve weights, resistance bands, or your body weight. For example:

    • Lifting light to moderate weights for 8–12 repetitions strengthens bones and muscles simultaneously.

    • Using resistance bands for exercises like squats or rows adds gentle strain that encourages bone rebuilding.

    • Bodyweight exercises such as planks, push-ups, or step-ups are effective and require no special equipment.

  • Balance training: Preventing falls is just as important as strengthening bones. Balance exercises, like tai chi or yoga, can keep you steady on your feet.

• Hormonal therapy:Menopausal hormone therapy (MHT) has been extensively studied for its effects on bone health. Research shows that MHT can reduce the risk of fractures by 30–50% in postmenopausal women. It works by slowing the rate of bone loss and, in some cases, promoting new bone formation. MHT is particularly effective if started near the onset of menopause, as this is when bone loss is most rapid. However, it should be tailored to individual needs and reviewed regularly with a healthcare provider.

• Non-hormonal treatments:For women who cannot or choose not to use MHT, medications such as bisphosphonates (e.g., alendronate) or denosumab can slow bone loss and reduce the risk of fractures. These treatments are highly effective and may be considered for women at high risk of osteoporosis.

Osteoporosis, the condition where bones become brittle and fragile, is more than a medical diagnosis—it’s a life-altering condition. Fractures, especially of the hip, can have a profound impact on quality of life. Nearly half of women who sustain a hip fracture will lose their ability to walk unaided, and recovery often requires extended rehabilitation.

Fractures in older age can also lead to a cascade of other health problems, including chronic pain, reduced mobility, and even increased mortality risk. That’s why proactive bone health care during menopause isn’t just about avoiding breaks—it’s about preserving your independence and vitality for years to come.

Even small daily habits can have a significant impact on your bone health:

• Quit smoking: Smoking impairs the cells that build bones, leading to weaker bones and a higher risk of fractures.

• Limit alcohol: Excessive drinking reduces calcium absorption and increases fracture risk. Stick to the recommended limits of no more than 14 units per week.

• Stay active: Movement is medicine for your bones. Even short, consistent activities like brisk walking can help.

References:

1. Long G et al. Predictors of osteoporotic fracture in postmenopausal women: a meta-analysis. J Orthop Surg Res. 2023 Aug 5;18(1):574. 

2. Zhu L et al.. Effect of hormone therapy on the risk of bone fractures: a systematic review and meta-analysis of randomized controlled trials. Menopause. 2016 Apr;23(4):461-70.

3. British Menopause Society. Prevention and treatment of osteoporosis in postmenopausal women. https://thebms.org.uk/publications/overview/ 

4. National Osteoporosis Guideline Group (2021). Clinical guideline for the prevention and treatment of osteoporosis.