MOVE WELL • BONE HEALTH

Menopause and bone health:
how to protect your bones.

LAST REVIEWED: 2026-10-29 • By the LatelyWell editorial team • How we write & review

Bone loss speeds up around menopause, and osteoporosis usually causes no symptoms until a bone breaks. Here is what the NHS, ACOG and NICE say about why it happens, who is most at risk, how bone health is checked, and the everyday steps that help.

Why menopause affects your bones

Bone is living tissue. Throughout life, old bone is broken down and new bone is built. ACOG explains that bone mass peaks in the late teens, stays roughly balanced in early adulthood, and that in midlife bone starts to be broken down faster than it is made.

Oestrogen (estrogen) helps protect against bone loss. After menopause the ovaries make very little oestrogen, and ACOG says this triggers a period of rapid bone loss that starts about 1 year before the final period and lasts for about 3 years. The NHS also says women lose bone rapidly in the first few years after menopause.

That is why bone health is part of good menopause care. The NICE menopause guideline asks clinicians to give advice on bone health to people going through menopause and to discuss it at review appointments.

What osteoporosis is, and why it is easy to miss

Osteoporosis weakens bones so that they are fragile and more likely to break. The NHS says it develops slowly over several years and is often only diagnosed when a fall or sudden impact causes a fracture. The most common breaks are in the wrist, hip and spine.

Osteoporosis is not usually painful until a bone breaks. ACOG notes that it may cause no symptoms for decades, and that small fractures in the spine can lead to loss of height or a slight curve in the spine, sometimes without pain. ACOG also says osteoporosis is four times more common in women than in men.

The stage before osteoporosis is called osteopenia: bone density is lower than average for your age but not low enough to be called osteoporosis. The NHS says osteopenia does not always lead to osteoporosis, and there are steps you can take to protect your bones.

Who is at higher risk?

The NHS says women are at greater risk of osteoporosis, particularly if menopause starts early (before 45) or if they have had their ovaries removed. Other risk factors listed by the NHS and ACOG include:

• a family history of osteoporosis, especially a parent who broke a hip
• taking high-dose steroid tablets for more than 3 months, and some other long-term medicines, such as some breast cancer treatments, some anti-seizure medicines and the contraceptive injection
• conditions such as rheumatoid arthritis, other inflammatory or hormone-related conditions, and conditions that affect how you absorb food
• a low body mass index (ACOG gives a BMI under 20 as an example), or a past eating disorder
• smoking, heavy drinking and not exercising regularly

If any of these apply to you, it is worth raising bone health with your doctor, even if you feel well.

How bone health is checked

Doctors can estimate your chance of breaking a bone using a risk calculator such as FRAX (the NHS also mentions Q-Fracture). ACOG says people aged 40 or over may be screened with FRAX, which uses factors such as age, BMI, smoking, alcohol and medical history to predict fracture risk over the next 10 years.

You may also be offered a bone density (DEXA or DXA) scan. The NHS describes it as a short, painless scan. Your result is given as a T-score, comparing your bone density with that of a healthy young adult:

• above −1: normal
• between −1 and −2.5: osteopenia (some bone loss)
• below −2.5: osteoporosis

Who gets a scan, and when, depends on where you live and on your risk. In the US, ACOG says everyone aged 65 and older should have a bone density test, and people under 65 who are past menopause should have one if they have a high risk of fractures. In the UK, the NHS says your doctor may refer you for a scan if they suspect osteoporosis, alongside working out your fracture risk.

Everyday steps that help your bones

1. Do weight-bearing and strength exercise

The NHS recommends exercise where your feet and legs support your weight (like walking, running or dancing) and resistance exercise, such as using weights. ACOG says exercise slows bone loss after menopause, and that balance work such as tai chi, yoga and Pilates can reduce the risk of falls. NICE also asks clinicians to explain why keeping up muscle mass and strength matters during menopause.

If you are new to it, our guide to strength training after 40 has a simple starting routine. If you already have osteoporosis or a past fracture, ask your doctor or a physiotherapist which exercises are right for you.

2. Get enough calcium, ideally from food

Recommendations differ between countries. The NHS says adults need 700mg of calcium a day and that most people can get this from a varied diet. In the US, the NIH Office of Dietary Supplements recommends 1,200mg a day for women aged 51 to 70. It also notes that the body absorbs and keeps less calcium after menopause.

Good sources include milk, yoghurt and cheese, green leafy vegetables such as kale (the NHS notes the body cannot absorb all the calcium in spinach), calcium-fortified soya drinks, and fish where you eat the bones, such as sardines.

3. Think about vitamin D

Vitamin D helps your body absorb calcium. In the UK, the NHS says everyone should consider a daily supplement of 10 micrograms (400 IU) of vitamin D in autumn and winter, and some people all year round. It advises not taking more than 100 micrograms (4,000 IU) a day unless a doctor advises it.

4. Be careful with supplements

ACOG says calcium and vitamin D supplements come with a small increased risk of kidney stones. If you do not have osteoporosis, are not vitamin D deficient and have never had a fracture, ACOG says it is best to get calcium and vitamin D from food. The NIH adds that calcium is absorbed best in doses of 500mg or less at a time, and that calcium supplements can interact with some medicines, including levothyroxine and some antibiotics. Check with your doctor or pharmacist before starting supplements.

5. Do not smoke, and keep alcohol down

Both the NHS and ACOG list smoking and heavy drinking as risk factors for osteoporosis.

6. Make falls less likely

A fall is what turns fragile bones into a fracture. ACOG suggests removing loose rugs and clutter, keeping rooms well lit (with a night light), using handrails on stairs and in the bathroom, having your eyesight checked, and asking whether any of your medicines affect your balance.

What about HRT?

The NHS says taking HRT can reduce the risk of osteoporosis. The NICE guideline explains that the risk of fragility fractures falls while you are taking HRT, that this benefit is kept during treatment but decreases once treatment stops, and that it may last longer in people who take HRT for longer.

HRT has benefits and risks that depend on your age, health and history, so whether it is right for you is a decision to make with a doctor. If you already have osteoporosis or a high fracture risk, there are also bone-strengthening medicines your doctor can discuss with you. Our guide to common HRT questions explains more.

Our free symptom tracker and guide to preparing for a menopause appointment can help you note your risk factors and questions before you go.

Frequently asked questions

Does menopause cause bone loss?

Yes. Lower oestrogen after menopause speeds up bone loss. ACOG says a period of rapid bone loss starts about a year before the final period and lasts about 3 years, and the NHS says women lose bone rapidly in the first few years after menopause.

What are the early signs of osteoporosis?

Often there are none. The NHS says osteoporosis is often only found when a bone breaks after a fall or knock. ACOG notes that fractures in the spine can cause loss of height or a curved spine, sometimes without pain.

When should I have a bone density scan?

It depends on your risk and where you live. In the US, ACOG says everyone 65 or older should have one, and younger people past menopause should have one if their fracture risk is high. Ask your doctor whether a fracture risk assessment or scan is right for you.

How much calcium do I need after menopause?

The NHS says adults need 700mg a day. The US NIH recommends 1,200mg a day for women aged 51 to 70. Most people can get a lot of this from food; talk to a doctor before taking supplements.

Does HRT protect your bones?

The NHS says HRT can reduce the risk of osteoporosis. NICE says the lower fracture risk is maintained during treatment but decreases after HRT stops. Whether HRT suits you is a decision to make with a doctor.

Where to find reliable information

If you want to read further, these organisations publish free, evidence-based information for the public:

• UK: the NHS menopause pages, the NICE menopause guideline and the Women's Health Concern factsheets from the British Menopause Society.
• US: The Menopause Society, ACOG and the National Institute on Aging.
• Australia: Jean Hailes for Women's Health and the Australasian Menopause Society.

Guidance differs a little between countries, and treatment names and availability vary, so check what applies where you live and talk to a clinician about your own situation.

The bottom line

Bone loss around menopause is normal, but osteoporosis is not inevitable. Regular weight-bearing and strength exercise, enough calcium and vitamin D, not smoking, limiting alcohol and preventing falls all help. If you have risk factors, ask your doctor about a fracture risk assessment rather than waiting for a broken bone.

Educational information only; not medical advice, diagnosis or treatment. Seek professional care for symptoms that are severe, persistent, worsening or concerning.