Menopause & Bone Health

The drop in estrogen during menopause speeds up bone loss. Estrogen is essential for bone health because bone cells have estrogen receptors. Bone is constantly being renewed in a process called remodeling. Old bone is broken down by cells called osteoclasts while new bone is built by osteoblasts. Estrogen plays an important role in keeping this process in balance. When estrogen levels drop at menopause, bone breakdown speeds up and bone building is not able to keep up leading to bone loss.

Bone loss starts during perimenopause, but the greatest decline occurs in the first 10 years after the final menstrual period. After that, the rate of loss slows but continues over time. Women who enter menopause early or prematurely start losing bone at a younger age, leaving them at greater risk of low bone density and fractures later in life.⁸

To diagnose osteoporosis, a bone mineral density test can be done to measure bone mass. It is also important to consider all risk factors to better understand the likelihood of further bone loss and fractures. A fragility fracture (a break from a minor injury) after age 40 is usually a sign of osteoporosis, and once one fracture has occurred, the chance of another is high. Current practice focuses on assessing overall fracture risk by looking at both bone density and individual risk factors, to estimate the chance of a fracture in the next 10 years.⁹

Although bone loss from menopause cannot be fully reversed, it can be managed. Lifestyle choices such as regular physical activity, quitting smoking, limiting alcohol and caffeine, and ensuring enough calcium, protein, vitamin K, vitamin D and magnesium all help protect bones. For women at higher risk, treatment options are available, including menopausal hormone therapy and other osteoporosis medications designed to slow bone loss and lower fracture risk.⁹