Menopause can bring about various changes that cause a wide range of symptoms — some may affect the body, some influence emotions, and others impact both. Osteoporosis, or the loss of bone density, falls into the third category of symptoms; physically, it tends to make the bones weak and more prone to fractures, and psychologically, osteoporosis and fractures are seen to increase the risk of anxiety, depression, or loneliness.
Studies suggest that women may lose 10% to 20% of their bone density during the first few years of the menopausal transition.(1) Taking steps to support bone density can help reduce the risk of fractures and improve quality of life during menopause. This page explores the causes, symptoms, and management strategies for osteoporosis during menopause.
Why does menopause increase osteoporosis risk?
Estrogen plays a crucial role in maintaining bone density by supporting bone formation and reducing bone breakdown. When estrogen levels drop during menopause, bone resorption (breakdown) can outpace bone formation.(1) This imbalance in bone formation and bone loss can reduce bone density.
The decline in estrogen levels can also increase cytokine levels. Cytokines are small proteins that stimulate the production and activity of the cells responsible for breaking down bone (osteoclasts). This heightened osteoclast activity can accelerate bone resorption, which can cause bones to break down faster than they can be rebuilt.(1)
Musculoskeletal Syndrome of Menopause and Osteoporosis
Musculoskeletal syndrome of menopause is an umbrella term that includes muscle loss, decreased bone density, and a higher risk of fractures. Since osteoporosis involves a reduction in bone density and increased fracture risk, it can be considered part of this syndrome.
The drop in estrogen level during menopause is a major contributing factor to this syndrome, as estrogen has a protective effect on bones and muscles. Musculoskeletal syndrome also tends to cause tendon and ligament injuries, increasing the risk of frozen shoulder and arthritis.(2)
Menopausal Osteoporosis Symptoms
Osteoporosis often develops quietly until a fracture occurs. However, some early warning signs can include the following:(1)
Back pain or a hunched posture due to spine fractures
Loss of spinal height over time
Bones that break easily, even from minor falls
Diagnosis and Testing for Osteoporosis
Early detection and management of osteoporosis are crucial to prevent potential fractures. It is recommended that individuals discuss their risk of osteoporosis and the need for tests with their doctors to confirm their bone health.
Doctors diagnose osteoporosis by measuring bone density with a DEXA scan, a specialized imaging technique. Based on the results, individuals receive either a T-score, which compares their bone density to that of younger individuals, or a Z-score, which compares it to others in their age group.(3)
The scan typically focuses on the hip but may also examine the spine, wrist, or ankle. For those diagnosed with osteoporosis or at high risk of developing it, doctors may recommend scans every 1–3 years to monitor progress. In other cases, screening may be necessary every five years.
The U.S. Preventive Services Task Force recommends screening for osteoporosis in women aged 65 and older to help prevent fractures. For postmenopausal women under 65, screening is suggested if they are at increased risk, based on a clinical risk assessment.(4)
Menopausal and Postmenopausal Osteoporosis Prevention and Treatment
Treatment approaches to manage or prevent the risk of osteoporosis during menopause can include the following:(1),(3),(5),(6)
Medications
There are several medications available to help manage osteoporosis and improve bone health:
Bisphosphonates: One of the most common treatments for osteoporosis, bisphosphonates can reduce bone loss by slowing the breakdown of bone tissue.
Denosumab: This medicine can prevent bone breakdown by inhibiting the cells that cause bone resorption.
Teriparatide: Studies indicate that this medicine can support new bone formation and reduce fracture risk, especially for high-risk individuals.
Romosozumab: This medication is known to increase bone formation and decrease bone resorption, thereby improving bone density and strength.
Lifestyle Modifications
Experts recommend the following lifestyle changes to support bone health during menopause:
Eating a diet rich in calcium and vitamin D: Calcium strengthens bones, while Vitamin D enhances calcium absorption. Dairy products, leafy greens, and fortified foods are rich in calcium and vitamin D and can support overall bone strength.
Exercising: Regular exercise is essential for maintaining bone health, as it enhances muscle strength and balance and lowers the risk of falls and fractures. It’s recommended to engage in 30–40 minutes of physical activity five days a week. Exercises that are particularly beneficial for bone health include weight-bearing activities (stair walking, skipping, running, tennis, dancing) and strength training (weight machines, dumbbells, push-ups, squats). A 2023 review suggests that water-based exercises can also help improve bone density and can be a great option for individuals who are afraid or unable to perform weight-bearing exercises.(7)
Making healthy lifestyle choices: It can also help to limit alcohol intake, quit smoking, and maintain a healthy weight, as these can further contribute to better bone health.
Hormone Replacement Therapy (HRT)
HRT helps improve the balance of female hormones by providing them externally. Studies show that women who take HRT experience increases in bone mineral density of 5.4% in the lumbar spine, 3.0% in the forearm, and 2.5% in the femoral neck after one year.
Over two years, these gains can increase to 6.8%, 4.5%, and 4.1%, respectively. HRT can also reduce the risk of non-vertebral fractures by 27%, with even more significant reductions in hip and wrist fractures.(1),(3)
Can HRT reverse osteoporosis?
While HRT can help improve bone mineral density and reduce the risk of fractures in individuals with osteoporosis, it may not completely reverse the condition. HRT is shown to slow bone loss and improve bone strength in some women. However, maintaining bone health typically requires ongoing treatment and lifestyle changes in addition to HRT.
Experiencing menopausal osteoporosis? Discover if HRT is right for you.
If you’ve entered the menopause transition and are struggling with osteoporosis, you don’t have to suffer in silence. Take our brief menopause quiz to see if you’re an eligible candidate for HRT. Get started with Winona to take the first step toward feeling better.
