Postmenopause and Bone Health: Protecting Your Bones After Menopause

Bone loss speeds up around menopause because estrogen helps keep bone strong. Bone density falls by about 2% a year for roughly three years around the final period, then more slowly. Worldwide, 1 in 3 women over 50 will have an osteoporotic fracture. Exercise, calcium, vitamin D, not smoking and treatment when needed all help protect bones.

Why does menopause affect your bones?

Bone is constantly broken down and rebuilt. Estrogen helps keep that process balanced. When estrogen falls, bone breakdown outpaces rebuilding.

The SWAN study found that a phase of fast bone loss starts about a year before the final period, often when periods have already stopped for three months or more. Bone density then falls by roughly 2% a year for about three years, with greater loss in the spine than the hip. After that, loss continues more slowly, adding up to about 10% over a decade. Bone quality and strength decline too.

For how this fits with other changes, see what happens to your body after menopause.

How common is osteoporosis after menopause?

According to the International Osteoporosis Foundation:

• 1 in 3 women over 50 worldwide will have a fracture caused by osteoporosis.
• About 21% of women over 50 have osteoporosis globally, compared with about 6% of men.
• Nearly 75% of hip fractures happen in women.

Hip fractures often lead to chronic pain, reduced mobility and loss of independence. This is why prevention matters.

What raises your risk of osteoporosis?

The US Preventive Services Task Force (USPSTF) lists key risk factors including:

• Being postmenopausal
• Low body weight
• A parent who broke a hip
• Smoking
• Heavy alcohol use

Other important factors include:

• Early menopause or premature ovarian insufficiency, especially without hormone therapy. See early menopause.
• Removal of both ovaries before natural menopause. See surgical menopause.
• Long-term steroid tablets and some other medicines
• Previous fractures from minor falls
• Conditions affecting bone, such as rheumatoid arthritis or conditions that affect absorption of nutrients

Do you need a bone density test?

Bone density is measured with a DXA scan, a quick, low-dose X-ray of the hip and spine. Recommendations vary by country:

• United States: In 2025, the USPSTF recommended screening all women aged 65 and over. For postmenopausal women under 65, it suggests first checking for risk factors, then using a risk-assessment tool, and screening those at increased risk.
• Australia: The 2024 national guideline encourages earlier identification of poor bone health using risk factors and a fracture risk calculator such as FRAX, rather than widespread population screening.
• UK and elsewhere: Clinicians typically assess fracture risk using tools such as FRAX, then arrange a DXA scan if needed.

If you have early menopause, the 2024 international guideline on premature ovarian insufficiency recommends a DXA scan at diagnosis where available.

Ask your clinician whether a risk assessment or bone density scan is right for you. See recommended health checks after menopause.

What is a fracture risk calculator?

Bone density is only part of the picture. Fracture risk calculators, such as FRAX and the Garvan calculator, combine your age, weight, fracture history, family history, smoking, alcohol, steroid use and other factors. They estimate your chance of a major fracture over the next ten years. The USPSTF lists these tools as options for deciding who under 65 should be screened. The 2024 Australian guideline particularly encourages FRAX.

Understanding a bone density result

A DXA scan reports a T-score, which compares your bone density with that of a healthy young adult:

• Around −1 or above: normal bone density
• Between −1 and −2.5: lower-than-normal bone density, sometimes called osteopenia
• −2.5 or below: osteoporosis

Your clinician will interpret the result alongside your overall fracture risk, which is what guides treatment decisions.

Bone health after early or surgical menopause

If you reached menopause before 45, you have more years without estrogen’s protection. The 2024 international guideline on premature ovarian insufficiency recommends:

• A bone density scan at diagnosis, where available
• Hormone therapy to maintain bone density and prevent osteoporosis
• Avoiding delays in starting hormone therapy, and taking it consistently

See early menopause and surgical menopause.

How can you protect your bones?

Exercise

Weight-bearing and resistance exercise put healthy stress on bones and build the muscle that protects them. Good options include:

• Strength training, such as weights, resistance bands or bodyweight exercises, at least twice a week
• Weight-bearing activity, such as brisk walking, stair climbing and dancing
• Balance training, such as tai chi or single-leg stands, to reduce the risk of falls

If you already have osteoporosis or have had a fracture, ask a physiotherapist which exercises are safe and effective for you.

Calcium and vitamin D

The International Osteoporosis Foundation advises that:

• Calcium from food is the preferred source, such as dairy, fortified plant milks, tofu, sardines, leafy greens and almonds.
• Supplements are recommended for people at high risk who don’t get enough, and for those receiving osteoporosis treatment.
• Calcium alone doesn’t reduce fracture risk, but calcium with vitamin D may modestly reduce it.

Vitamin D helps you absorb calcium. Many people need a supplement, particularly in winter or with limited sun exposure. Recommended amounts vary by country, so check local guidance or ask your clinician.

Lifestyle

• Don’t smoke. Smoking weakens bones.
• Keep alcohol low. Heavy drinking raises fracture risk.
• Avoid being underweight, and eat enough protein to maintain muscle.
• Reduce fall risk with good lighting, removing trip hazards, sensible footwear, and eye and hearing checks.

What treatments can prevent bone loss?

• Hormone therapy. The Menopause Society notes that for people under 60 or within 10 years of menopause without contraindications, hormone therapy’s benefit-risk balance is favorable for preventing bone loss and reducing fractures, as well as for treating hot flashes. For people with early menopause, it’s recommended until at least the average age of menopause.
• Osteoporosis medicines. Bisphosphonates and other bone-strengthening medicines are used when fracture risk is high. The USPSTF found convincing evidence that treating women 65 and over who have osteoporosis moderately reduces fractures.

Treatment decisions depend on your fracture risk, age, other health conditions and preferences. See your first menopause appointment for questions to ask.

Get checked promptly if you have:

• A fracture from a minor fall or bump, such as a broken wrist from falling from standing height
• Sudden severe back pain, especially with loss of height, which can signal a spinal fracture
• Noticeable loss of height or a curving upper back

Questions to ask your clinician

1. What is my fracture risk, and should I have a bone density scan?
2. Are any of my medicines affecting my bones?
3. Do I need calcium or vitamin D supplements?
4. Would hormone therapy help protect my bones?
5. If I have osteoporosis, which treatment suits me, and for how long?
6. Which exercises are safe and useful for me?

Frequently asked questions

When does bone loss start in menopause?

According to SWAN, fast bone loss starts about a year before the final period and continues for around three years, before slowing.

Can you rebuild bone after menopause?

Exercise and treatment can slow bone loss, and some medicines can increase bone density. Maintaining muscle and preventing falls also reduce fracture risk.

Should I take calcium supplements after menopause?

Food is the preferred source. Supplements are usually recommended if you don’t get enough from your diet and are at higher risk, or are being treated for osteoporosis.

Does HRT protect bones?

Yes, hormone therapy prevents bone loss and reduces fractures. Guidance describes its benefit-risk balance as favorable for this purpose in people under 60 or within 10 years of menopause without contraindications.

How often should I have a bone density scan?

It depends on your results and risk. The 2024 POI guideline suggests that, with normal results and consistent hormone therapy, repeating a scan within five years has limited value. Your clinician will advise based on your situation.

References

1. SWAN fact sheet: Bone health over the menopause transition
2. Bone health during the menopause transition and beyond (SWAN review)
3. International Osteoporosis Foundation: Epidemiology of osteoporosis and fragility fractures
4. International Osteoporosis Foundation: Calcium
5. USPSTF: Screening for osteoporosis to prevent fractures, 2025
6. USPSTF final recommendation bulletin, January 2025
7. 2024 RACGP and Healthy Bones Australia guideline for osteoporosis management and fracture prevention
8. ESHRE/ASRM/IMS: Evidence-based guideline on premature ovarian insufficiency, 2024
9. The 2022 hormone therapy position statement of The North American Menopause Society
10. Healio: USPSTF final recommendation on osteoporosis screening (risk assessment tools)
11. 2022 NAMS position statement summary (bone loss and fracture), Mayo Clinic

Editorial status: evidence-based educational article; not individually medically reviewed. Last evidence check: September 10, 2026.

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