A clear, practical guide to understanding bone changes, protecting your long-term health, and knowing when treatment is needed.
Why Menopause Matters for Bone Health
Bone is living tissue that constantly renews itself. Throughout adulthood, the body maintains a balance between breaking down old bone and building new bone. As we enter our late thirties, this balance begins to shift. Around the time of menopause, falling oestrogen levels accelerate bone loss, often faster than the body can rebuild it.
This is why the years around menopause are a key period for protecting bone health. Oestrogen plays an essential role in maintaining bone strength, so when levels drop, bones gradually become thinner and more fragile. This increases the long-term risk of fractures, particularly of the hip, wrist and spine.
One in three women over 50 will break a bone, and fractures can significantly affect mobility, independence and overall health. Supporting bone strength early makes a meaningful difference to long-term wellbeing.
What Is Osteoporosis?
Osteoporosis is a condition where bones have lost enough density and structure to become fragile. Most women do not realise their bones have weakened until they experience a fracture, as osteoporosis itself has no symptoms.
Risk increases if you:
- have a family history of osteoporosis
- are in menopause and not taking HRT
- smoke
- drink more than the recommended alcohol limits
- have medical conditions such as rheumatoid arthritis, gut malabsorption or hyperthyroidism
- take steroid tablets or other medication that affects bone health such as some breast cancer treatments, anti-epileptics, anti-depressants or anti-acids.
- have a low body weight
If you are concerned about your risk, you can ask your doctor for a FRAX assessment. This calculates your individual fracture risk and helps determine whether further investigation or treatmetn is needed.
Bone Density Scans (DEXA)
A DEXA scan measures bone density at key sites such as the hip and spine. It is the gold-standard test for diagnosing osteoporosis and guiding treatment.
A scan may be recommended if you:
- have a high risk score on FRAX
- have broken a bone after a minor fall
- have early menopause or premature ovarian insufficiency
- take medication known to affect bone health
- have medical conditions that increase risk
Results are reported using T-scores, which compare your bone density with that of a healthy young adult. Your clinician will explain what the results mean for you and whether treatment or monitoring is appropriate.
The Royal Osteoporosis Society has helpful resources if you would like more information about scans and what to expect.
How to Keep Your Bones Strong
Good bone health requires a combination of lifestyle measures, dietary choices and, for some women, medication. The most effective approach is to combine these strategies.
1. Hormone Replacement Therapy (HRT)
HRT replaces the oestrogen that naturally declines during menopause. Oestrogen helps slow bone loss and reduces the risk of fractures. Current guidance from NICE and BMS supports the use of HRT to:
- prevent osteoporosis in women under 60 who have increased risk
- treat bone loss related to early menopause or premature ovarian insufficiency
- improve bone density when taken at adequate doses
For many women in their fifties, HRT is as effective as other medical treatments for maintaining bone strength. It can be combined with other osteoporosis treatments if needed.
2. Eat for Bone Health
Calcium
Adults need around 700 to 1200 mg of calcium daily. If you avoid dairy or have a low intake, you may need supplementation. Foods rich in calcium include:
- dairy products
- leafy greens
- almonds and sesame seeds
- fortified plant milks
- tinned fish with soft bones
- dried figs and apricots
The Royal Osteoporosis Society offers a calcium calculator to help you assess your dietary intake.
Vitamin D
Vitamin D is essential for absorbing calcium. Sources include oily fish, eggs and fortified foods, but in the UK most women need a daily supplement, particularly from October to April.
Other nutrients
Iron, magnesium and protein all support bone strength. These can be found in vegetables, pulses, nuts, seeds, whole grains and lean meats.
Maintaining a healthy body weight is also important. Being significantly under- or overweight increases fracture risk.
3. Exercise Regularly
Exercise is one of the most powerful tools we have for protecting bone density.
Weight-bearing exercise
This includes activities where you support your own body weight while moving. Examples include:
- walking
- climbing stairs
- dancing
- jogging
- racket sports
- skipping or hopping
Smoking and Alcohol: Their Impact on Bone Health
Smoking
Smoking has a direct and harmful effect on bone. It slows down the cells that build new bone and accelerates bone loss. Women who smoke reach menopause earlier, which further increases their risk of osteoporosis. Smoking also impairs calcium absorption and reduces blood supply to bone. The positive news is that bone health begins to improve once you stop, and fracture risk gradually returns towards that of a non-smoker.
Alcohol
Drinking more than the recommended limits (14 units per week) increases the risk of osteoporosis and fractures. Alcohol affects the way bone tissue is formed and can interfere with the body’s ability to absorb key nutrients. In the short term, alcohol makes falls more likely due to reduced balance and slower reaction times. Keeping alcohol intake within safe limits is an important part of maintaining long-term bone strength.
Other Medical Treatments for Bone Health
When osteoporosis is diagnosed or fracture risk is high, medications may be recommended alongside lifestyle measures and HRT (if appropriate). These treatments help strengthen bone and reduce the chance of future fractures.
Bisphosphonates
These are the most commonly prescribed osteoporosis medicines. They slow down bone breakdown so the body can rebuild stronger bone.
Examples: Alendronic acid, risedronate, ibandronate, zoledronic acid (infusion).
How they are taken: Usually weekly or monthly tablets, or annual intravenous treatment.
Key points: Very effective at reducing fracture risk. Tablets need to be taken on an empty stomach with water, while staying upright for 30 minutes.
Denosumab
A twice-yearly injection that reduces bone resorption.
Useful if bisphosphonates are unsuitable or not tolerated.
Teriparatide and other anabolic treatments
Daily injections that help build new bone.
Reserved for severe osteoporosis or when fractures continue despite standard therapy.
Your doctor will help choose the right option based on your scan results, risk factors and medical history.
