Menopause And Bone Health: What Every Woman Should Know
Article written by Dr Emma Ginns and Dr Mari Walling, British Menopause Society Registered Specialist GPs, Co-founders of Lemala Health, April 2026
This information is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for personal guidance.
In this guide, we explain how menopause impacts bone health, and what you can do to reduce your future risk of osteoporosis and fractures. We will review why these changes occur, and what action you can take now, to improve your long-term health.
Why does menopause affect bone health?
Oestrogen plays an important role in maintaining bone strength.
From around our mid-30s, bone density gradually declines. However, during the menopause transition, this process can accelerate due to falling oestrogen levels.
This can lead to:
A reduction in bone density
Changes in bone structure
An increased risk of fractures over time
Bone is constantly being broken down and rebuilt. After menopause, the balance shifts towards more breakdown than rebuilding.
How is bone health assessed?
Bone health is not just about a scan result.
In the UK, digital tools such as FRAX are often used by clinicians to estimate your overall risk of fracture. This takes into account a range of factors including:
Age
Weight and BMI
Smoking
Alcohol intake
Family history of osteoporosis or early fractures
Medical conditions and current or past medications (especially steroids).
A DEXA scan measures bone density and can help guide decisions, but it is only one part of the picture. Your overall fracture risk is often more important than the scan result alone.
What is the difference between osteopenia and osteoporosis?
You may have heard these terms if you have had a bone scan (DEXA scan):
Osteopenia means bone density is lower than expected, but not low enough to be classed as osteoporosis.
Osteoporosis means bone density is significantly reduced, and fracture risk is higher.
It’s important to know that many fractures actually occur in women with osteopenia, simply because it is more common.
So even if you are told your bone density is “borderline” or “mildly reduced”, it is still worth being pro-active in supporting your bone health longer term.
Who may be at higher risk?
Some women are more likely to experience reduced bone strength, including those who:
Go through menopause earlier (including premature ovarian insufficiency), or surgical menopause without subsequent HRT
Have had long periods without oestrogen exposure
Have a low body weight
Smoke or drink higher levels of alcohol
Have a family history of osteoporosis or fractures
Have certain medical conditions (such as inflammatory conditions or thyroid disorders)
Have used medications such as long-term steroids
Periods of immobility, significant illness, or conditions affecting nutrient absorption can also impact bone health.
What can help support bone health?
There are several ways to support your bones during and after menopause.
Movement and exercise
Weight-bearing and resistance exercise are particularly important for maintaining bone strength.
This might include:
Walking, jogging, or hiking
Strength training
Pilates or yoga can be helpful for balance and falls prevention
Nutrition
Adequate intake of calcium and vitamin D is important.
Where possible, calcium from food sources is preferred.
Vitamin D supplementation is often recommended in the UK, particularly in Autumn and Winter.
Lifestyle factors
Keeping alcohol within recommended limits
Avoiding smoking
Maintaining a healthy weight
Even small, consistent changes can make a difference over time.
Hormone Replacement Therapy (HRT)
HRT can help maintain bone density and reduce fracture risk, particularly when started around the time of menopause.
For many women under 60, HRT is considered an effective option for both symptom relief and bone protection.
The decision to use HRT is always individual and should take into account your overall health and preferences.
Other treatments
In some cases, medications specifically for bone health may be recommended.
These are usually considered when fracture risk is higher, rather than based on bone density alone.
Why early awareness matters
One important point is that the risk of further fractures is highest in the first couple of years after an initial fracture.
This means that identifying and supporting bone health early - before or soon after any issues arise - can be particularly important.
When should you seek advice?
It may be worth discussing bone health with a healthcare professional if you:
Have gone through menopause, particularly if it was early
Have risk factors for osteoporosis
Have experienced a fracture
Are unsure whether you need assessment or a scan
Are considering HRT and want to understand its wider benefits
Related resources:
You may also find these resources helpful:
Menopause and perimenopause symptom checker - see if your symptoms might be hormonal.
Understanding perimenopause symptoms – a guide to common hormonal symptoms and what to expect
Further support and information
BMS consensus statement: Prevention and treatment of osteoporosis in post menopausal women
Women’s Health Concern: Osteoporosis - bone health following the menopause
In summary
Bone health is an important, but often overlooked, part of menopause care.
The changes that occur during this time are common - but there is a lot that can be done to support bone strength and reduce future risk.
With the right information and a personalised approach, many women can take simple steps that have long-term benefits for their health and wellbeing.
How We Can Help
If you would like personalised advice on menopause, bone health, or whether further assessment may be helpful, we are here to support you.
At Lemala Health, we provide individualised, evidence-based menopause care, helping you find a treatment approach that fits your symptoms, health and lifestyle.