How does menopause affect your bones?

Menopause affects your bones because oestrogen, the hormone that falls at menopause, helps keep them strong. The NHS says that after menopause, falling oestrogen can lead to a rapid drop in bone density, which is why women are more at risk of osteoporosis (bones that become weak and break more easily) than men. You can’t feel this happening, but there’s a lot you can do: eat enough calcium, keep active on your feet, look after your vitamin D, and talk to your GP if you’re at higher risk.

Why bone loss speeds up at menopause

Bone is living tissue that’s constantly being broken down and rebuilt. Women’s Health Concern (WHC), the patient arm of the British Menopause Society, explains that after menopause more bone is removed than replaced, so bones get thinner and more fragile.

Everyone loses some bone with age. The NHS says bones are strongest until your late 20s and you gradually start losing bone from around 35. But WHC says the major bone loss in women happens with the loss of oestrogen at menopause. The HSE puts it simply: women who have been through menopause have a higher risk of osteoporosis because of the lower level of oestrogen in the body.

Who is most at risk

The NHS says women are at greater risk if they have had:

an early menopause, before 45
a hysterectomy before 45, particularly if the ovaries were also removed
periods that stopped for more than 6 months because of over-exercising or too much dieting

Other risk factors the NHS lists include:

a family history of osteoporosis, or a parent who broke a hip
long-term use of high-dose steroid tablets, such as for asthma or arthritis
a body mass index (BMI) of 19 or less
heavy drinking and smoking
rheumatoid arthritis
conditions that affect how you absorb food, such as coeliac disease or Crohn’s disease
an eating disorder, now or in the past
an overactive thyroid
some breast cancer treatments that affect hormone levels
long periods of inactivity, such as bed rest

Having one of these doesn’t mean you’ll get osteoporosis. It means it’s worth raising bone health with your GP.

How bone health is checked

WHC says osteoporosis can be diagnosed after a break from a minor fall, typically of the wrist, spine or hip, but it can also be found before any break with a DEXA scan. This is a type of X-ray scan that measures bone density. It gives a “T-score” comparing your bones with those of a healthy young adult, which shows whether your bone density is normal, a bit low (sometimes called osteopenia) or in the osteoporosis range.

Not everyone needs a scan. Your GP can tell you whether one makes sense for you, based on your risk factors.

What you can do for your bones

Calcium

The HSE says adults aged 19 to 64 need 700mg of calcium a day, and that you should be able to get all you need from your diet. Good sources include milk, cheese, yogurt and other dairy foods, green leafy vegetables like kale, soya drinks with added calcium, bread made with fortified flour, and fish where you eat the bones, such as sardines. WHC notes that reduced-fat dairy has just as much calcium.

If you think you’re not getting enough, for example if you’re vegan, the HSE suggests talking to your GP about a supplement. The HSE also warns not to take too much, as this could be harmful.

Vitamin D

Vitamin D helps your body use calcium to build strong bones. The HSE says sunlight on your skin triggers your body to make it, and suggests talking to your GP about a vitamin D supplement. In the UK, WHC says people at risk of osteoporosis, or taking an osteoporosis medicine, are advised to take a daily supplement of 20 micrograms (800 IU). Check with your GP or pharmacist about what’s right for you.

Exercise

Both the HSE and WHC recommend:

weight-bearing exercise, where your feet and legs carry your weight, such as brisk walking, dancing or running
resistance or muscle-strengthening exercise, such as using weights

Smoking and alcohol

The HSE advises getting help to stop smoking if you smoke, and cutting down on alcohol, as both are linked to weaker bones.

HRT and other treatments

The HSE says HRT helps prevent osteoporosis by raising your oestrogen level, and that this is particularly important if your periods stop before 45. WHC says HRT has been shown to reduce the risk of fractures and can be used to prevent or treat osteoporosis after menopause. Like any medicine, HRT has risks as well as benefits, which depend on the type and on your health (see our guide to the risks of HRT).

There are also non-hormonal bone medicines. WHC describes several, including bisphosphonates, which slow down bone loss and are taken as a weekly or monthly tablet or given as an injection. Your GP or a specialist will explain which, if any, suit you. Calcium and vitamin D on their own aren’t a treatment for osteoporosis, WHC says, but they support other treatments.

Never start, stop or change a medicine for your bones without talking to your GP or pharmacist first.

Ireland and the UK

The advice on food, exercise and risk factors is the same in both countries. In Ireland, HRT is free at participating pharmacies with a medical card or Drugs Payment Scheme card (our guide explains how). In both countries, start with your GP, who can arrange a bone scan if it’s needed.

What to do next

Check the risk list above and note anything that applies to you, especially an early menopause or a family history of osteoporosis or hip fracture.
Raise bone health at your next GP visit, even if you’re there for something else. Ask: am I at higher risk? Would a DEXA scan help? Should I take vitamin D?
Look at your calcium. Do you have dairy or other calcium-rich foods most days? If not, add one, such as yogurt or kale.
Add weight-bearing exercise you enjoy, like a brisk walk or a dance class, plus some strength work such as using weights.