Bone Strength During Menopause: Protecting Your Skeletal Health

Bone health is an often-overlooked aspect of menopause, yet it plays a critical role in overall well-being. The European Menopause and Andropause Society (EMAS) defines bone strength as a combination of bone density (measured in grams per square centimetre) and bone quality. Bone density depends on factors such as peak bone mass and the extent of bone loss over time.

Understanding the causes of bone loss and exploring prevention and treatment options is vital for maintaining health during menopause. By taking proactive steps, individuals can strengthen their bones and reduce the risk of fractures, ensuring resilience throughout this life stage and beyond.

What Causes Bone Loss During Menopause?

Bone loss begins during perimenopause as the body produces less oestrogen. While oestrogen is best known for its role in reproductive health, it also regulates the balance between bone formation and resorption. As oestrogen levels decline, this balance is disrupted, leading to accelerated bone loss.

According to the UK’s National Health Service (NHS), women lose up to 10% of their bone density within the first five years after menopause. This significant reduction in bone mass increases the risk of osteoporosis—a condition characterised by fragile, porous bones.

Beyond oestrogen deficiency, other factors contribute to bone fragility, including:

• Family history of osteoporosis
• Smoking and alcohol consumption
• Low levels of physical activity
• Insufficient calcium and vitamin D intake

These factors, combined with menopause-related hormonal changes, make proactive bone health management essential.

Lifestyle Changes to Support Bone Health

A proactive approach to bone health begins with simple lifestyle changes. It’s important to consult your doctor or a registered menopause healthcare professional before making any significant adjustments.

Nutrition

A diet rich in calcium and vitamin D is crucial. According to EMAS, women should aim for 700–1,200 mg of calcium per day, primarily from food sources such as:

• Dairy products (milk, cheese, yogurt)
• Leafy greens (spinach, kale)
• Fortified foods (plant-based milks, cereals)

Vitamin D enhances calcium absorption, and a daily intake of 800–1,000 IU is recommended. Good sources include:

• Fatty fish (salmon, mackerel)
• Egg yolks
• Fortified products

Exercise

Regular physical activity, especially weight-bearing and resistance exercises, helps maintain bone density. Research by the National Institutes of Health shows these activities can stimulate bone retention and even moderately increase bone mass. Exercises like walking, jogging, and strength training are particularly effective.

Lifestyle Adjustments

• Quit Smoking: Smoking accelerates bone loss and increases fracture risk.
• Limit Alcohol: Excessive alcohol consumption weakens bones and should be avoided.

Medical Interventions

Hormone Replacement Therapy (HRT)

HRT remains one of the most effective options for maintaining bone density during menopause. By replacing declining oestrogen levels, HRT can help prevent osteoporosis. However, it’s important to discuss the risks and benefits of HRT with a healthcare professional, as suitability varies based on individual medical histories.

Healthcare providers may also recommend regular bone density scans (DEXA scans) every two years to monitor bone health and detect any early signs of bone loss.

Pharmacological Treatments

For those at higher risk of osteoporosis, medications like bisphosphonates are often prescribed. These drugs slow bone loss and are available as oral tablets or intravenous infusions. Other medications may also be recommended, but they should only be taken under the guidance of a healthcare professional.

Empowering Yourself with Knowledge

Bone loss during menopause is a significant concern, but it doesn’t have to be inevitable. By adopting a balanced diet, engaging in regular exercise, and exploring medical treatments when needed, you can take charge of your bone health.

Working closely with a healthcare provider ensures access to the right tools, from lifestyle recommendations to advanced therapies. With the right approach, you can maintain strong, healthy bones and reduce the risk of fractures, safeguarding your overall well-being for years to come.