Your Bones Are Changing in Menopause. Here’s What You Can Do

This article is for you if you are in perimenopause or menopause, have a family history of osteoporosis, have experienced a fracture, or simply want to understand what happens to your bones as your hormones change.

Bone health is one of those things that can be easy to ignore. Unlike hot flashes, sleep changes or irregular periods, you cannot feel your bone density changing.

But your bones are living tissue. Throughout your life, old bone is constantly being broken down and replaced with new bone. During menopause, that balance begins to change.

Why menopause matters for your bones

Estrogen plays an important role in maintaining bone. As estrogen levels decline around menopause, bone breakdown begins to happen faster than bone formation. The period of more rapid bone loss often begins around the final menstrual period and continues for several years afterward.¹

This is one reason osteoporosis becomes increasingly important to think about as women move through midlife.

Osteoporosis means bones have become weaker and more susceptible to fracture. The spine, hip and wrist are some of the areas commonly affected.

And osteoporosis is often silent. You may not know your bone density has declined until a fracture occurs.

That is why I would much rather have women thinking about their bones before there is a problem.

Calcium matters, but it is not the whole story

When we think about bone health, calcium is usually the first nutrient that comes to mind.

And yes, calcium matters. Your body needs calcium to build and maintain bone. Current Canadian recommendations suggest women over age 50 aim for approximately 1200 mg of calcium per day, ideally through food when possible.¹

Calcium rich foods can include:

• Dairy products such as yogurt, milk and cheese
• Fortified plant beverages
• Calcium set tofu
• Sardines with bones
• Leafy greens
• Sesame seeds and tahini

Before automatically reaching for a supplement, I like to look at how much calcium you are actually getting from food.

Sometimes supplementation is helpful. Sometimes food is enough. Your needs depend on your diet, health history and individual risk factors.

Do not forget vitamin D

Vitamin D helps your body absorb calcium and supports normal bone mineralization and muscle function.

This becomes especially relevant in Canada, where sunlight exposure varies significantly throughout the year. Canadian osteoporosis guidance recommends that adults over age 50 consume vitamin D rich foods and take at least 400 IU of supplemental vitamin D daily.¹

Individual needs may differ depending on your diet, vitamin D status, medications and other health factors.

More is not automatically better. Supplementation should make sense for your individual situation.

Your bones need resistance

Nutrition gives your body the building blocks it needs, but your bones also need a reason to stay strong.

Bone responds to load.

Walking is valuable for cardiovascular health, mobility and overall wellness, but it should not be the only movement we think about for healthy aging.

Progressive resistance training, weight bearing exercise and balance training can help maintain bone strength, muscle strength and physical function. Canadian guidelines recommend progressive resistance training at least twice weekly, along with balance and functional training.¹

That might include:

• Squats or sit to stands
• Lunges
• Resistance bands
• Free weights
• Gym machines
• Carrying appropriately challenging loads
• Balance exercises

You do not need to become a bodybuilder. You simply need to challenge your muscles and bones consistently.

Hormones are also part of the conversation

This is where menopause care becomes much more individualized.

Menopausal hormone therapy is not only used for symptoms such as hot flashes and night sweats. Systemic hormone therapy has also been shown to prevent bone loss and reduce fracture risk.³

Does this mean every woman should take hormone therapy for her bones?

No.

Hormone therapy needs to be considered in the context of your age, symptoms, personal health history, risk factors and preferences. For some women, it may be one part of their bone health strategy. For others, non hormonal strategies or osteoporosis medications may be more appropriate.

This is one of the conversations we will explore in my upcoming webinar, Perimenopause and Menopause With or Without Hormones.

I want women to understand that menopause care is not simply a choice between taking hormones or doing nothing. There are many ways to support your health, and your options should make sense for you.

What else affects osteoporosis risk?

Hormones are important, but they are not the only factor influencing bone health.

Your risk can also be affected by:

• Family history of osteoporosis or hip fracture
• Previous fractures
• Smoking
• Higher alcohol intake
• Low body weight
• Certain medications
• Some medical conditions
• Nutrition
• Physical activity
• Fall risk

This is why bone health deserves a broader conversation than simply telling women to take calcium.

Should you have a bone density scan?

A bone mineral density scan, commonly called a DEXA or DXA scan, measures bone density and can help assess fracture risk.

Whether you need one depends on factors such as your age, fracture history, medications and other osteoporosis risk factors. Canadian guidelines emphasize looking at overall fracture risk rather than bone density alone.¹

If you are approaching menopause and have risk factors for osteoporosis, it is worth discussing bone health and appropriate screening with your healthcare provider.

5 Ways to Start Protecting Your Bones

1. Look at your calcium intake

Spend a few days noticing how many calcium rich foods you regularly eat. You may already be getting enough, or you may notice easy opportunities to add more.

2. Think about vitamin D

Make sure vitamin D is part of your bone health conversation, especially if you live somewhere with limited sunlight for part of the year.

3. Pick up something heavy

Resistance exercise becomes increasingly important as we age. Start at a level that feels appropriate for your body and gradually increase the challenge.

4. Know your risk factors

Family history, previous fractures, medications and certain medical conditions can change how closely we should be watching your bones.

5. Learn about hormonal and non hormonal options

There is no single menopause plan that fits every woman. Knowing your options allows you to make decisions based on your health, your risks and what matters to you.

The bigger picture

Menopause is not simply about managing hot flashes.

It is an opportunity to start thinking about how you want your body to feel and function over the next several decades.

Your bones are part of that conversation. So are your muscles, heart, brain, sleep, metabolism and quality of life.

You do not need to become afraid of osteoporosis. But I do want you to know that your bones are changing, and there are things you can do now to support them.

If this made you think of your mom, sister, friend or another woman in your community, share it with her.

The more openly we talk about what happens to our bodies during menopause, the easier it becomes for women to ask better questions and make informed decisions about their health.