Bone loss after menopause: osteoporosis risk and prevention
Bone loss speeds up after menopause because estrogen helps keep bones strong. About half of women over 50 will break a bone due to osteoporosis. A bone density scan shows your risk, and exercise, enough calcium and vitamin D, and medicines when needed can lower it.
See a doctor if you break a bone in a minor fall, lose height, or develop new back pain or a stooped posture. Ask about a bone density scan if you had menopause before 40 or have other risk factors.
What it is and how common it is
Bone is constantly broken down and rebuilt. Bone loss means it is broken down faster than it is rebuilt. Mild thinning is called osteopenia. When bones become weak enough to break easily, it is osteoporosis.7
About 1 in 2 women over 50 will break a bone because of osteoporosis.1 In the US, about 80% of the 10 million people with osteoporosis are women, including about 1 in 4 women aged 65 or older.2
Osteoporosis is often silent until a bone breaks, most often in the hip, wrist or spine. Spine fractures can cause back pain, lost height and a stooped posture.2
Why it happens in menopause
Estrogen is key to rebuilding bone. When it falls at menopause, bone loss speeds up.1,7 Estrogen loss is the main driver of osteoporosis after menopause.4
Women can lose up to a fifth of their bone density in the 5 to 7 years after menopause. Some lose bone faster than others.1,7
Your risk is higher if you had menopause before 40 or have a low body weight. Smoking, heavy drinking, a family history and a past broken bone also raise it.7 Building less bone when young also raises risk later.1,2
What else can cause it, and screening
Some health conditions and medicines thin bones too. A doctor may check for an overactive thyroid, parathyroid disease, rheumatoid arthritis or lupus. Gut conditions that affect absorption, eating disorders and long periods of immobility also matter.1,7
Bone density is measured with a DXA (or DEXA) scan, a quick, low-dose X-ray.2,7 In the US, the Preventive Services Task Force recommends screening all women 65 and older. It also recommends screening younger postmenopausal women at higher risk.3
Risk calculators help decide who needs a scan, but many are less accurate for Asian, Hispanic and Black women.3 Screening advice differs between countries, so ask your doctor what applies to you.
Everyday measures
- Get calcium and vitamin D, ideally from food. If you get too little, your doctor may suggest supplements and advise on the type and amount.2
- Do weight-bearing exercise. Brisk walking, dancing and running load the bones.2,7
- Add strength training. Weights, bands or bodyweight exercises such as squats also help.7
- Do not smoke, and limit alcohol to no more than one drink a day.2
These habits help, but good diet and exercise alone do not stop osteoporosis once it has developed. That is why some women also need medicine.4
What helps: options rated
| Option | Evidence | What the research shows |
|---|---|---|
| Osteoporosis medicines | Medicines that slow bone breakdown, such as bisphosphonates and denosumab, are the usual first choice. Women at very high risk may start with a bone-building medicine.4 | |
| Hormone therapy (HRT) | Prevents bone loss and reduces fractures.7 The Menopause Society calls it the most appropriate option to prevent bone loss in healthy women at menopause, especially those with symptoms.4 It carries risks to discuss with a doctor.1 | |
| Weight-bearing and strength exercise | Recommended by health agencies.2 In a small trial of 28 women with low bone mass, 8 months of supervised heavy training improved hip and spine density. No one was injured.6 | |
| Calcium and vitamin D | Both are needed for healthy bones.2 But in healthy postmenopausal women, low-dose supplements did not prevent fractures. This finding does not apply to women with osteoporosis or a deficiency.5 | |
| Not smoking and limiting alcohol | Recommended by bone health groups and health agencies as part of prevention.1,2 |
Ratings explained: how we rate. Always talk to a doctor or pharmacist before starting a medicine or supplement.
Related
Sources
- What women need to know, Bone Health & Osteoporosis Foundation
- Osteoporosis fact sheet, Office on Women's Health, US Department of Health and Human Services (2025)
- Task force issues final recommendation on osteoporosis screening in older women, Healio (2025)
- News release on The North American Menopause Society 2021 osteoporosis position statement, EurekAlert! (2021)
- Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in adults, US Preventive Services Task Force (2018)
- Watson SL et al. Early findings from the LIFTMOR trial of high-intensity resistance training in postmenopausal women with low bone mass, Osteoporosis International (2015)
- Osteoporosis, My Menopause Centre