Menopause and Bone Loss: How to Prevent Osteoporosis

You’ve prob­a­bly been keep­ing tabs on the menopause changes you can feel. The 3AM wake-ups. The hot flash that shows up halfway through a meeting.

Your bones are chang­ing, too. They just aren’t telling you about it.

As estro­gen drops, bone can break down faster than your body rebuilds it. In the five to sev­en years after menopause, women can lose up to 20% or more of their bone den­si­ty. The upside is that weak­er bones aren’t a done deal. The right habits, screen­ing, and care can help you stay strong and steady for decades.

Menopause and Bone Health at a Glance

• Bone loss speeds up around menopause: Low­er estro­gen tips the bal­ance between break­ing down old bone and build­ing new bone.
• You usu­al­ly can’t feel it: Many peo­ple don’t learn they have osteo­poro­sis until they break a bone, often in the spine.
• Exer­cise is one of your best tools: Strength, weight-bear­ing, and bal­ance train­ing help pro­tect both your bones and your balance.
• Treat­ment works: If you already have low bone den­si­ty or have bro­ken a bone, a per­son­al­ized plan can low­er your chance of anoth­er fracture.

Why Menopause Speeds Up Bone Loss

Bone is liv­ing tis­sue that’s always under ren­o­va­tion. Your body breaks down old bone and replaces it with new bone through­out your life, and estro­gen helps keep that swap even.

When estro­gen falls, the demo­li­tion crew starts out­pac­ing the build­ing crew. For many women, osteo­poro­sis begins to devel­op a year or two before menopause, and loss is fastest for sev­er­al years after the final period.

That mat­ters because about one in two women over age 50 will break a bone due to osteo­poro­sis. Those breaks hap­pen most often in the hip, spine, and wrist.

Osteope­nia means your bone den­si­ty is low­er than nor­mal but not yet low enough to be called osteo­poro­sis. Think of it as a yel­low light, not a red one.

What Rais­es Your Risk?

Every woman los­es some bone with age, but cer­tain fac­tors make osteo­poro­sis more like­ly:

• Ear­ly menopause, or hav­ing your ovaries removed before nat­ur­al menopause.
• A par­ent or sib­ling with osteo­poro­sis or a bro­ken hip.
• A small, slen­der frame.
• A past frac­ture from a minor fall or bump.
• Long-term use of med­i­cines like steroids, or health con­di­tions that affect bone.
• Smok­ing, heavy drink­ing, low activ­i­ty, or not enough cal­ci­um and vit­a­min D.

Signs Your Spine May Be Affected

Osteo­poro­sis is called a silent dis­ease because it typ­i­cal­ly has no symp­toms until a bone breaks. The spine is where that silence can be most misleading.

A ver­te­bral com­pres­sion frac­ture hap­pens when a weak­ened spinal bone col­laps­es slight­ly. Some cause sud­den, sharp back pain. Oth­ers cause no symp­toms at first and only show up on an X‑ray tak­en for some­thing else.

Over time, spine frac­tures can lead to:

• Los­ing height, so your pants seem a lit­tle longer than they used to be.
• A round­ed upper back or stooped posture.
• Back pain that comes on sud­den­ly or after a minor strain, like lift­ing a laun­dry basket.

If you notice any of these, or you’ve bro­ken a bone after age 50, talk with your provider about a bone health evaluation. >

When to Get a Bone Den­si­ty Test

A bone den­si­ty test, often called a DXA scan (dual-ener­gy X‑ray absorp­tiom­e­try), is a quick, pain­less scan of your hip and low­er spine. The U.S. Pre­ven­tive Ser­vices Task Force rec­om­mends screen­ing for all women 65 and old­er, plus post­menopausal women under 65 who have risk factors.

Results come back as a T‑score, which com­pares your bone den­si­ty to that of a healthy young adult. In gen­er­al, ‑1.0 or high­er is nor­mal, below ‑1.0 but above ‑2.5 is osteope­nia, and ‑2.5 or low­er is osteo­poro­sis. Your provider will look at that num­ber along­side your age, frac­ture his­to­ry, and med­ica­tions to gauge your real frac­ture risk.

Also read: What in the World Is a Bone Den­si­ty Scan, and Do I Need One?

Won­der­ing if it’s time for a bone den­si­ty test?

Your Duly pri­ma­ry care provider can review your risk fac­tors and order a DXA scan through Duly Radi­ol­o­gy, with loca­tions across the Chica­go suburbs.

Sched­ule with a Duly provider >

How to Pro­tect Your Bones and Spine

You don’t need test results to start. Exer­cise does dou­ble duty here: it puts healthy stress on your bones and builds the mus­cle and bal­ance that help keep you from falling in the first place.

• Strength train­ing. Hand weights, resis­tance bands, and body-weight moves like squats or wall push-ups sig­nal your bones to stay strong. Steady work­outs that grad­u­al­ly get a lit­tle hard­er are what count.
• Weight-bear­ing activ­i­ty. Walk­ing, hik­ing, danc­ing, climb­ing stairs, and ten­nis all have your legs car­ry­ing your body weight against grav­i­ty. Your dai­ly walk is a great start, and pair­ing it with strength work gives your bones a more com­plete workout.
• Bal­ance and pos­ture. For peo­ple with weak­er bones, a fall is more like­ly to cause a break. Tai chi, bal­ance drills, and exer­cis­es that strength­en your back mus­cles can help you stay steady and stand taller. If you have osteo­poro­sis or a past spine frac­ture, you may need to adjust some move­ments, espe­cial­ly repeat­ed bend­ing and twist­ing. A physi­a­trist or phys­i­cal ther­a­pist can show you how to stay active safely.
• Nutri­tion. Women over 50 need about 1,200 mil­ligrams (mg) of cal­ci­um a day, ide­al­ly from foods like milk, cheese, yogurt for­ti­fied plant milks, leafy greens, and canned salmon with bones. Vit­a­min D helps your body absorb that cal­ci­um, which can be a chal­lenge dur­ing a gray Chica­go-area win­ter. Enough pro­tein sup­ports the mus­cles that pro­tect your bones.

Also read: Frac­ture-Proof Your Bones.

Want an exer­cise plan that’s safe for your bones?

Duly’s osteo­poro­sis trained Phys­i­cal Ther­a­pists can build a strength, bal­ance, and pos­ture plan around your bone den­si­ty results, back pain, or past injuries, with­out surgery.

Explore Duly Physiatry >

What If You Already Have Osteope­nia or Osteoporosis?

Hear­ing you have low bone den­si­ty, or break­ing a bone, can feel unset­tling. It does­n’t mean anoth­er frac­ture is inevitable.

“What I wish patients knew about osteo­poro­sis is that they do have some con­trol over their bone health and can opti­mize bone health through exer­cise, a healthy diet, and med­ica­tions if nec­es­sary,” says Dr. Kim­ber­ly Mer­cu­rio, Depart­ment Chair of Physi­a­try and Bone Health Physi­cian Lead at Duly Health and Care. ​“T‑scores can be improved and frac­ture risk can be decreased sig­nif­i­cant­ly. Many patients are very sur­prised to learn that their T‑scores can be improved and that their risk can actu­al­ly decrease as they get old­er with appro­pri­ate intervention.”

Osteo­poro­sis is often treat­ed by your pri­ma­ry care provider, an endocri­nol­o­gist (a spe­cial­ist in hor­mones and metab­o­lism), or a rheuma­tol­o­gist (a spe­cial­ist in bones, joints, and mus­cles). Any of them can look for the rea­sons behind your bone loss, esti­mate your future frac­ture risk, and build a plan that fits you. That plan may include tar­get­ed exer­cise, fall pre­ven­tion, cal­ci­um and vit­a­min D, and a review of med­i­cines that affect bone.

Med­ica­tion is often part of the pic­ture, too. Some osteo­poro­sis med­i­cines slow bone loss, while oth­ers help rebuild bone and are often used when frac­ture risk is high. If a spine frac­ture is caus­ing pain, treat­ment may include pain relief and phys­i­cal ther­a­py to rebuild strength around your spine.

If you’re also man­ag­ing menopause symp­toms, ask your pri­ma­ry care provider or OB/GYN whether hor­mone ther­a­py is right for you. It has been shown to pre­vent bone loss and frac­tures in the right candidates. 

Fre­quent­ly Asked Ques­tions About Menopause and Bone Loss

• Does bone loss start dur­ing per­i­menopause? It can. For many women, bone loss begins a year or two before their final peri­od and speeds up for sev­er­al years after menopause.
• Can osteo­poro­sis cause back pain? Osteo­poro­sis itself usu­al­ly does­n’t hurt, but it can lead to com­pres­sion frac­tures in the spine, which may cause sud­den back pain, height loss, or a stooped pos­ture. Some spine frac­tures cause no pain.
• Is walk­ing enough to pre­vent osteo­poro­sis? Walk­ing is a great weight-bear­ing activ­i­ty, but adding strength and bal­ance train­ing gives your bones and mus­cles ben­e­fits that walk­ing alone can’t.
• Can you rebuild bone after menopause? You can main­tain or improve some bone den­si­ty with exer­cise, good nutri­tion, and med­ica­tion when need­ed. How much is pos­si­ble varies from per­son to person.

Give Your Bones Some Atten­tion Now

You can’t feel your bones chang­ing dur­ing menopause, but you’re far from pow­er­less. Strength and bal­ance train­ing, a bone-friend­ly diet, and time­ly screen­ing all add up, so you can keep lift­ing grand­kids, hik­ing trails, and car­ry­ing your own gro­ceries well into your 80s.

Already have osteo­poro­sis or a recent fracture?

Duly’s Bone Health Clin­ic eval­u­ates what caused your frac­ture, mea­sures your risk for future breaks, and builds a per­son­al­ized plan that can include med­ica­tion man­age­ment and nutri­tion coun­sel­ing. Ask your Duly provider for a refer­ral, or call 1−630−456−7631 to learn more.

Learn about the Bone Health Clinic >