menopause and osteoporosis

Bone loss is one of the few menopause changes you can't feel happening. There's no ache and no warning. For a lot of women, the first clue is a broken wrist or hip after a fall that shouldn't have done that much damage. Here's what's going on with your bones around menopause, what speeds the loss up, and what you can do about it, starting now.

The short version

• About one in two women over 50 will break a bone because of osteoporosis, according to the Bone Health and Osteoporosis Foundation.
• Bone loss speeds up after menopause. A woman can lose up to 20 percent of her bone density in the five to seven years that follow.
• Osteoporosis usually has no symptoms until a bone breaks, which is why a bone density scan matters.
• The US Preventive Services Task Force recommends screening for every woman 65 and older, and for younger postmenopausal women with risk factors.
• Weight-bearing and strength exercise, enough calcium and vitamin D, not smoking and going easy on alcohol are the everyday basics. Hormone therapy is also worth discussing with your doctor.

What is osteoporosis?

Osteoporosis means your bones have become thinner and weaker than they should be, so they break more easily. Bone is living tissue. Your body is always breaking down old bone and building new bone, and while you're young the building keeps up. Later in life the balance starts to tip the other way, and at menopause it tips faster.

It's more common than most women realize. The Bone Health and Osteoporosis Foundation estimates that approximately one in two women over 50 will break a bone because of osteoporosis. It also says a woman's risk of breaking a hip is equal to her combined risk of breast, uterine and ovarian cancer.

It's often called a silent disease. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, there are typically no symptoms until a bone is broken. When the spine is affected, the first signs can be back pain, losing height, or a stooped or hunched posture.

Read about osteoporosis: bone up on bone health

Why does bone loss speed up at menopause?

Estrogen helps protect your bones by slowing down the breakdown of old bone. When estrogen falls at menopause, that brake comes off, and bone is broken down faster than your body can rebuild it. The Bone Health and Osteoporosis Foundation says a woman can lose up to 20 percent of her bone density in the five to seven years after menopause.

That's why the years around your last period matter so much for your bones. The faster bone is lost, the sooner it can reach the point where a simple fall causes a fracture.

Who is most at risk?

Menopause is the biggest shift, but it isn't the only thing that counts. Your risk is higher if:

• you have a small or slender frame, because you have less bone to lose
• one of your parents broke a hip or had osteoporosis
• you smoke
• you drink heavily over the long term
• you take certain medicines for a long time (more on that below)

Background plays a part too. The Bone Health and Osteoporosis Foundation estimates that about 20 percent of White women and about 20 percent of Asian American women age 50 and older have osteoporosis, compared with about 10 percent of Latinas and 5 percent of African American women over 50. Lower risk isn't no risk, so these numbers are no reason to skip a scan.

Can your medications affect your bones?

Yes. Some common medicines can speed up bone loss. The Bone Health and Osteoporosis Foundation list includes:

• steroid medicines (glucocorticoids) such as prednisone. Taking 5 mg or more as pills for three months or longer raises the chance of bone loss
• aromatase inhibitors, often used after breast cancer, such as Arimidex, Aromasin and Femara
• some antiseizure medicines
• proton pump inhibitors for heartburn, such as Nexium, Prevacid and Prilosec
• SSRI antidepressants, such as Lexapro, Prozac and Zoloft
• thyroid hormone, when the dose is more than your body needs
• heparin, and the Depo-Provera birth control shot

Please don't stop or change any of these on your own. Many of them are important, and stopping some of them suddenly can be dangerous. If you take one long term, ask your doctor whether you need a bone density scan sooner, or extra support for your bones while you're on it.

What kind of exercise helps your bones?

Bone responds to load. When your muscles pull on your bones and your body works against gravity, it's a signal to keep bone strong.

Weight-bearing exercise. Walking, jogging, dancing, tennis, hiking, climbing stairs and jumping rope all count. If you haven't exercised in a while, start slowly and build up.

Strength training. Hand weights, resistance bands or your own body weight, such as squats or push-ups against a wall. Twice a week is a good goal, and it strengthens the muscles that protect you in a fall.

Balance work. Most fractures happen in a fall, so staying steady on your feet matters as much as bone density. Tai chi is a gentle, well-loved option, and a physical therapist can give you a routine to do at home.

If you've already been told you have low bone density, ask your doctor or a physical therapist which moves are safe for you before you start anything high impact or anything that involves a lot of bending and twisting.

Read more about protecting your bones naturally

What should you eat and drink for your bones?

Calcium. The NIH Office of Dietary Supplements recommends 1,200 mg a day for women 51 and older. Food first: yogurt, milk, cheese, sardines and canned salmon with the bones, fortified soy milk, tofu made with calcium, kale, broccoli, white beans, almonds and dried figs. If you use a supplement to fill the gap, keep your total from food and supplements under 2,000 mg a day, and split it up, because your body absorbs calcium best in doses of 500 mg or less at a time. More is not better here.

Vitamin D. You need it to absorb calcium. The recommended amount is 600 IU a day up to age 70 and 800 IU a day from 71, with an upper limit of 4,000 IU. Fatty fish, eggs, and fortified milk, plant milks and cereals help, but it's hard to get enough from food alone. A simple blood test can show where you stand, so ask your doctor before you guess at a dose.

Magnesium. The NIH Office of Dietary Supplements notes that people with higher magnesium intakes have higher bone mineral density. Women need 310 to 320 mg a day, and leafy greens, legumes, nuts, seeds and whole grains are the best food sources. If you take a supplement, the upper limit from supplements is 350 mg a day.

Cola. In the Framingham Osteoporosis Study, led by Dr. Katherine Tucker and published in the American Journal of Clinical Nutrition in 2006, women who drank more cola had lower bone density at the hip. Other carbonated drinks were not linked, and the pattern didn't show up in men. That study shows an association, not proof that cola causes bone loss, but if cola is a daily habit, it's an easy swap.

Coffee. Good news here. A 2002 review by Dr. Robert Heaney in Food and Chemical Toxicology found no evidence that caffeine harms bone in people who get the recommended amount of calcium. Its small effect on calcium absorption can be offset by 1 to 2 tablespoons of milk.

Alcohol and smoking. The National Institute of Arthritis and Musculoskeletal and Skin Diseases names chronic heavy drinking as a significant risk factor for osteoporosis, and smoking as a risk factor too. Keeping alcohol moderate and quitting smoking are two of the most useful things you can do for your bones.

When should you get your bones checked?

A bone density scan, usually a quick and painless DXA scan, is how osteoporosis is found before a fracture. In January 2025 the US Preventive Services Task Force recommended screening for all women 65 and older, and for postmenopausal women younger than 65 who are at increased risk. If any of the risk factors above sound like you, bring it up at your next appointment instead of waiting for 65.

See a doctor promptly if you have sudden, severe back pain, especially after a minor fall, bump or lift, or if you notice you've lost height or started to stoop. These can be signs of a fracture in the spine.

If your scan shows low bone density, your doctor may talk with you about prescription treatment. Hormone therapy is one of the options. The Menopause Society's 2022 position statement says it has been shown to prevent bone loss and fracture, and that for women younger than 60 or within 10 years of menopause, with no contraindications, the benefits outweigh the risks for treating hot flashes and preventing bone loss.

A correction we owe you

An earlier version of this page ended by saying hormone replacement therapy is associated with an increased risk of heart attack, stroke, blood clots, dementia and breast cancer, with nothing else to balance it. That was out of date, and it could have put you off a treatment that protects bone. The Menopause Society's 2022 hormone therapy position statement says the benefit-risk ratio is favorable for most healthy women younger than 60 or within 10 years of menopause onset. It also says the balance is less favorable for women who start more than 10 years after menopause or at 60 or older, because the absolute risks of heart disease, stroke, blood clots and dementia are higher. The risks are real. They just depend on your age, when you start, the type, dose and route of therapy, and your own health history, which is a conversation for you and your doctor.

We also removed a line telling you to avoid phosphorus-rich foods like red meat because phosphorus "can promote bone loss." That went further than the evidence. The better supported finding is narrower and is about cola, which is covered above.

Questions women ask about menopause and osteoporosis

How much bone do you lose after menopause?

It varies from woman to woman, but the Bone Health and Osteoporosis Foundation says a woman can lose up to 20 percent of her bone density in the five to seven years after menopause. The drop in estrogen is the main reason, because estrogen helps slow the breakdown of bone.

Does osteoporosis have symptoms?

Usually not until a bone breaks. The National Institute of Arthritis and Musculoskeletal and Skin Diseases calls it a silent disease for that reason. When the spine is affected, the first signs can be back pain, losing height, or a stooped posture.

When should I get a bone density test?

The US Preventive Services Task Force, in its January 2025 recommendation, advises screening for all women 65 and older, and for postmenopausal women younger than 65 who are at increased risk. Risk factors include a parent who broke a hip, smoking, heavy drinking, a small or slender frame, and long-term use of medicines like steroids.

Does hormone therapy help protect your bones?

Yes, it can. The Menopause Society's 2022 hormone therapy position statement says hormone therapy has been shown to prevent bone loss and fracture, and that for women younger than 60, or within 10 years of menopause onset, with no contraindications, the benefit-risk ratio is favorable for treating hot flashes and preventing bone loss. Whether it is right for you depends on your age, health history and the type of therapy, so talk it through with your doctor.

How much calcium do I need after menopause?

The NIH Office of Dietary Supplements sets the recommended amount at 1,200 mg a day for women 51 and older, from food and supplements combined. The upper limit is 2,000 mg a day. If you take a supplement, your body absorbs it best in doses of 500 mg or less at a time.

Is coffee bad for your bones?

Not if you get enough calcium. A 2002 review by Dr. Robert Heaney in Food and Chemical Toxicology found no evidence that caffeine harms bone in people who get the recommended amount of calcium, and said the small effect of caffeine on calcium absorption can be offset by 1 to 2 tablespoons of milk.

Bottom line

Bone loss speeds up in the years after menopause, and it happens quietly. You can't feel it, so the best move is to know your risk, ask about a bone density scan, and lean on the basics the research supports: weight-bearing and strength exercise, balance work, enough calcium and vitamin D, going easy on alcohol, and not smoking. If you're under 60 or within 10 years of your last period, hormone therapy is worth a real conversation with your doctor too. It's never too late to start looking after your bones.