Bone Health
Bone loss accelerates dramatically after menopause — but you won't feel it until a fracture happens. Prevention starts now.
20%
Bone Loss in First 5-7 Years
Post-menopause
1 in 2
Women Will Break a Bone
After age 50
80%
Of Osteoporosis Patients
Are women
0
Symptoms Until Fracture
Silent disease
The Silent Crisis
Osteoporosis has no symptoms. You can't feel your bones weakening. Most women don't know they have it until they break a bone — often from something as minor as a sneeze, a hug, or stepping off a curb.
10 million
Americans have osteoporosis — 80% are women
This is preventable. Unlike some aspects of menopause, bone loss can be measured, slowed, and even reversed with the right interventions. The key is knowing your baseline, understanding your risk, and taking action before a fracture happens.
Bone Loss Timeline
Estrogen plays a key role in bone maintenance. When it declines, bone breakdown accelerates faster than bone building.
How Bone Loss Accelerates at Menopause
Pre-Menopause
~0.5% loss/year
Estrogen supports bone
Rapid Loss Phase
2-3% loss/year
First 5-7 years post-meno
Continued Loss
1-2% loss/year
Ongoing without intervention
The rapid loss phase is your critical window for intervention. Action now prevents fractures later.
Understanding T-Scores
Early menopause = earlier bone loss: Women who experience menopause before age 45 (naturally or surgically) start losing bone earlier. If this is you, get a DEXA scan now and discuss prevention aggressively with your doctor.
Risk Factors
Some risks you can't change. Others you can. Know where you stand.
What Increases Your Risk?
🧬 Non-Modifiable
- Female sex (lower peak bone mass)
- Age (risk increases with age)
- Family history of osteoporosis or fractures
- Small frame / low body weight
- White or Asian ethnicity
- Early menopause (before 45)
- History of fractures as adult
⚠️ Medical Factors
- Long-term steroid use (prednisone, etc.)
- Thyroid disorders / excess thyroid hormone
- Rheumatoid arthritis
- Celiac disease / malabsorption
- Eating disorder history
- Breast cancer treatments
- Gastric bypass surgery
🚬 Lifestyle (Modifiable)
- Smoking (significantly increases risk)
- Excessive alcohol (>2 drinks/day)
- Sedentary lifestyle
- Low calcium intake
- Vitamin D deficiency
- Excessive caffeine
- High sodium diet
✅ Protective Factors
- Weight-bearing exercise history
- Higher body weight (within healthy range)
- Adequate calcium and vitamin D
- Muscle mass / strength
- Hormone therapy use
- Late menopause
- History of pregnancies
DEXA Scan: Know Your Baseline
A DEXA (DXA) scan measures bone density. It's quick, painless, and essential.
Understanding Your Results
≥ -1.0
Normal
Bone density is within healthy range. Continue prevention strategies.
-1.0 to -2.5
Osteopenia
Bone density is below normal but not yet osteoporosis. Action needed now.
≤ -2.5
Osteoporosis
Significantly low bone density. High fracture risk. Treatment usually recommended.
When to Get Tested
All women: Baseline DEXA at menopause or age 65, whichever comes first. Earlier if: You have risk factors, early menopause, prior fracture, long-term steroid use, or significant height loss. Repeat: Every 1-2 years if osteopenia/osteoporosis, otherwise per doctor recommendation.
📋 What to Ask for
- T-score: Compares you to young adult peak bone mass
- Z-score: Compares you to others your age
- Sites measured: Spine and hip are most important
- Trend over time: Compare to previous scans
- FRAX score: 10-year fracture risk calculation
📍 Where to Get Tested
- Order through your doctor (PCP, gynecologist, endocrinologist)
- Done at hospitals, imaging centers, some clinics
- Takes about 10-15 minutes
- No preparation needed
- Covered by insurance at recommended intervals
Prevention Strategies
You can slow bone loss significantly — and in some cases, rebuild bone — with the right approach.
Highest Impact
Weight-Bearing & Resistance Exercise
Bones respond to stress by getting stronger. Weight-bearing exercise and strength training stimulate bone formation. This is the single most powerful non-pharmaceutical intervention.
→ Strength train 2-3x/week + daily weight-bearing activity
Highest Impact
Calcium + Vitamin D
Calcium is the building block. Vitamin D is required for absorption. Without both, bones can't maintain themselves. Most women don't get enough of either.
→ 1200mg calcium + 1000-2000 IU vitamin D daily
Hormone Therapy
HRT preserves bone density effectively. The bone benefit is one reason some women choose HRT. Discuss individual risks/benefits with your doctor.
→ Discuss with doctor if within 10 years of menopause
Quit Smoking
Smoking accelerates bone loss and doubles fracture risk. Quitting at any age helps — bone health can improve after stopping.
→ Quit now — every year smoke-free helps
Limit Alcohol
More than 2 drinks/day interferes with calcium absorption and bone formation. Moderate or eliminate alcohol intake.
→ Max 1 drink/day, ideally less
Bone-Supporting Nutrition
Beyond calcium and D: adequate protein supports bone matrix, vitamin K helps calcium reach bones, magnesium is a structural component.
→ See Diet dashboard for details
Best Exercises for Bone Health
High-Impact Weight-Bearing
Jumping, running, tennis, dancing, hiking
⭐ Best for building bone
Resistance Training
Weight lifting, resistance bands, bodyweight exercises
⭐ Essential for bone + muscle
Low-Impact Weight-Bearing
Walking, elliptical, stair climbing
Good for maintenance
Balance Training
Tai chi, yoga, single-leg exercises
Critical for fall prevention
Swimming / Cycling
Non weight-bearing cardio
Great for fitness, less for bones
Core Strengthening
Planks, bird-dogs, bridges
Supports spine, prevents falls
Bone-Building Nutrients
Calcium Essential
Target: 1200mg/day (from food first)
Dairy, fortified plant milk, sardines, leafy greens, tofu
Vitamin D Essential
Target: 1000-2000 IU/day (often need supplement)
Sunlight, fatty fish, fortified foods, supplements
Protein
Target: 1.0-1.2g per kg body weight
Fish, poultry, eggs, legumes, dairy — supports bone matrix
Vitamin K
Target: 90-120mcg/day
Leafy greens (kale, spinach), fermented foods (K2)
Magnesium
Target: 320mg/day
Nuts, seeds, whole grains, leafy greens
Collagen / Protein
Consider: 10-15g collagen peptides
Bone broth, supplements — emerging evidence for bone
Treatment Options
If you have osteoporosis or high fracture risk, medications can significantly reduce fracture risk.
Osteoporosis Medications
Bisphosphonates
Most commonly prescribed
Alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), zoledronic acid (Reclast). Slow bone breakdown.
Taken weekly, monthly, or yearly depending on type. Well-established safety profile.
Denosumab (Prolia)
Injection every 6 months
Blocks cells that break down bone. Often used when bisphosphonates aren't suitable or don't work.
Must not miss doses — stopping abruptly can cause rapid bone loss.
Romosozumab (Evenity)
Bone-building agent
Actually builds new bone (anabolic). Monthly injection for 1 year. For very high-risk patients.
Newer, more expensive. Usually followed by another medication.
Hormone Therapy
Preventive / Early treatment
HRT effectively prevents bone loss and reduces fracture risk. Primary benefit is within 10 years of menopause.
May be preferred option if also treating menopausal symptoms.
Treatment decisions are individualized. Factors include your T-score, FRAX score (10-year fracture risk), age, other health conditions, and personal preferences. Many women with osteopenia can prevent progression with lifestyle measures alone; those with osteoporosis usually benefit from medication.
Why Prevention Matters: Fracture Consequences
20%
of hip fracture patients die within 1 year
50%
never regain previous function
25%
require long-term care afterward
Fall Prevention
The best bone won't help if you fall. Fall prevention is half the fracture equation.
🏠 Home Safety
- Remove loose rugs and clutter
- Install grab bars in bathroom
- Ensure good lighting, especially stairs
- Use non-slip mats in shower/tub
- Keep frequently used items at easy height
- Secure electrical cords
- Consider night lights for nighttime
🧍 Personal Prevention
- Balance exercises: Tai chi, yoga, single-leg stands
- Strength training: Strong muscles prevent falls
- Vision checks: Annual eye exams, update glasses
- Medication review: Some meds increase fall risk
- Proper footwear: Supportive, non-slip soles
- Rise slowly: Especially from lying/sitting
- Limit alcohol: Affects balance and judgment
✓ Your Bone Health Action Plan
✓ Get a baseline DEXA scan at menopause or if you have risk factors
✓ Know your T-score and what it means
✓ Calculate your FRAX score (10-year fracture risk)
✓ Aim for 1200mg calcium daily (food first)
✓ Get vitamin D tested and supplement if needed
✓ Add weight-bearing exercise and strength training
✓ Quit smoking if you smoke
✓ Assess your home for fall hazards