Bone Health

Osteoporosis and Menopause: Essential Bone Health Strategies


You are probably familiar with menopause symptoms like hot flashes. Did you know that menopause also significantly affects your bones? Menopause is one of the major contributors to bone loss in women. Read on to learn about the importance of good bone health and how to combat bone loss in perimenopause and postmenopause.

Menopause and Bone Health

During menopause, estrogen levels drop rapidly. Estrogen plays a key role in keeping our bones strong, and this dip in estrogen results in loss of bone density. Research has shown that upwards of 20 percent of bone loss occurs within the first five years of menopause.

Additional risk factors for bone loss include smoking, excessive alcohol use, a sedentary lifestyle, poor nutrition, and certain medications.

Bone loss can lead to osteoporosis, a progressive bone disease that develops as bones become structurally weak due to loss of density. Weaker bone tissue leads to an increased risk of fractures or breaks. The National Osteoporosis Foundation estimates that half of all women over age 50 will eventually be diagnosed with osteoporosis. Most women with osteoporosis end up experiencing a fracture, with spine and hip fractures being the most serious. Fractures can lead to lower quality of life and early death.

Fortunately, research supports several key preventative strategies to help maintain and even increase bone density in perimenopause and beyond.

Strategies to Build Bone Density and Limit Bone Loss


Exercise is vital in preventing and treating osteoporosis. In fact, it is the only strategy that can improve all modifiable risk factors for osteoporosis-related injuries, including bone strength, fall risk, and fall impact. However, not all exercise effectively addresses bone density and reduces falls.

Resistance (strength) training strengthens your muscles and helps maintain bone density. These exercises use external resistance such as dumbbells, kettlebells, barbells, and resistance bands. 

The most effective resistance training programs for bone health use relatively heavy weights (at least 70 percent of your maximum possible weight for one repetition). Each exercise is performed for 2-3 sets of 8-12 repetitions with a rest between each set. Lifting heavier weights is safe even if you already have osteoporosis — and it may be even more important. If you are new to resistance training, starting with lower weight and working up as you get more comfortable is best. However, don’t be afraid to increase your weights to the point where you are working hard at the end of each set of 8-12 repetitions. These workouts also need to stay challenging, so you’ll need to increase your weights as you get stronger. 

Like our muscles, bone is living tissue that grows stronger with exercise. Weight-bearing exercises, like jogging or dancing, ask your bones to support the weight of your body plus impact. Impact is actually healthy for your joints and bones, including if you have osteoarthritis, but ramping it up gradually is the ideal way to avoid aches and pains. 


Eating a nutritious diet is another crucial component of good bone health. A recent review found that eating a diet rich in fruits, vegetables, whole grains, poultry, fish, nuts and legumes, and low-fat dairy was associated with high bone mineral density and a lower risk of fracture. Conversely, diets that include soft drinks, fried foods, processed meats, and refined grains increase the risk of osteoporosis. 

You’ve probably heard about the connection between calcium and bone health. Calcium is needed throughout our life for strong bones and to prevent the onset of osteoporosis. However, research shows that most people are not getting enough calcium in their diet. Women aged 50 and older should consume roughly 1,000 milligrams daily from food, including dairy products and leafy green vegetables.

Vitamin D helps us to absorb calcium better and, in turn, strengthens our bones. It also improves muscle strength which can help to prevent falls. Only a few foods, like salmon and tuna, are rich in vitamin D. Some cereals and dairy products are fortified with vitamin D, but not enough to get sufficient quantities. The best source of vitamin D is sunlight. Aim to spend about fifteen to thirty minutes in the sun around midday a few times each week.

If you drink alcohol, you may want to consider cutting back. Alcohol makes it harder for our bodies to properly absorb calcium and vitamin D. Heavy drinking can also decrease estrogen levels. The National Osteoporosis Foundation recommends limiting alcohol consumption to no more than two drinks per day.


Several medications are available to help prevent further bone loss and stimulate new bone growth.

Bisphosphonates are generally the first choice for the treatment of osteoporosis. This oral medication prevents and treats postmenopausal osteoporosis by slowing bone loss while increasing bone mass. 

Menopausal hormone therapy can also address bone loss. In addition to reducing hot flashes and other menopausal symptoms, menopausal hormone therapy is effective at preserving bone health and reducing the risk of osteoporosis. 

Assessing Your Risk for Osteoporosis

If you are concerned about your risk of developing osteoporosis, your healthcare provider can perform tests to assess your bone health. The gold standard test for bone density is a DEXA scan. DEXA is a quick, non-invasive scan that can provide information about your bone density at key sites like your wrist and hip bones. Your healthcare provider may also perform blood or urine tests to measure calcium levels.

Once you have a bone density measurement, your provider can help you understand your risk of a bone fracture due to osteoporosis in the context of other risk factors like age, stage of menopause, medications, and body size. 

Being proactive about bone health in perimenopause will help reduce your risk of developing osteoporosis and keep you healthy and active long into the future. Try incorporating some of these tips into your daily routine. Your bones will thank you!

Looking for more expert support on bone health and healthy aging? Download the Midday menopause app from the App Store or visit us at Midday.Health.

Erin Stanton, RDN, MPH, is a registered dietitian and certified lactation counselor residing in Atlanta, Georgia. She puts her master’s in public health degree to good use as a freelance writer focusing on various health and wellness topics, especially those pertaining to women and

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