Osteoporosis and menopause are closely connected, with postmenopausal women being particularly vulnerable to this bone-weakening condition. The primary reason is the sharp drop in oestrogen levels that occurs during menopause. Oestrogen plays a vital role in maintaining bone strength, and when its levels decline, bone loss accelerates, increasing the risk of fractures.

Understanding how menopause affects bone health and what can be done to prevent osteoporosis is crucial for long-term wellbeing.

How menopause affects bone health

Bones are constantly renewing themselves, with old bone being broken down and replaced by new bone. Two types of cells control this process:

• Osteoclasts break down old bone
• Osteoblasts build new bone

Before menopause, oestrogen helps keep these two processes in balance. However, as oestrogen levels drop, this balance is disrupted.

• Osteoclasts become more active, breaking down bone at a faster rate
• Osteoblast activity slows down, meaning new bone is not replaced quickly enough

This leads to bone thinning and increased fragility, making fractures more likely. Some women may lose up to 20 percent of their bone mass in the first few years after menopause.

Risk factors for osteoporosis after menopause

While menopause itself increases the risk of osteoporosis, other factors can make some women more vulnerable.

• Early menopause before the age of 45 increases the likelihood of significant bone loss
• Family history of osteoporosis or fractures raises the risk
• Ethnicity plays a role, with Caucasian and Asian women at higher risk
• Low body weight or a small frame means less bone mass to begin with
• Lack of physical activity, especially weight-bearing and strength exercises, weakens bones
• Poor diet, particularly low calcium and vitamin D intake, contributes to bone loss
• Smoking and excessive alcohol consumption accelerate bone deterioration
• Certain medications, such as corticosteroids, can affect bone strength

Osteoporosis often develops silently, with no symptoms until a fracture occurs. That is why prevention and early intervention are essential.

How to protect bone health after menopause

Although bone loss is a natural part of ageing, there are several ways to slow it down and keep bones strong.

1. Stay active with weight-bearing and strength exercises

Regular physical activity helps maintain bone strength and reduces the risk of fractures. The best types of exercise for bone health include:

• Weight-bearing exercises such as walking, dancing or jogging help strengthen bones
• Resistance training, like lifting weights or using resistance bands, encourages bone formation
• Balance and flexibility exercises, such as yoga or Pilates, reduce the risk of falls and fractures

Women who remain active tend to maintain better bone density than those who lead a sedentary lifestyle.

2. Eat a bone-healthy diet

Calcium and vitamin D are essential for strong bones. To support bone health:

• Aim for 700 milligrams of calcium daily in dairy products, leafy greens, nuts and fortified foods
• Get enough vitamin D, which helps the body absorb calcium. Sunlight is the best source, but supplements, especially in winter, may be needed
• Include protein, as it supports bone repair and density
• Eat magnesium-rich foods such as nuts, seeds and whole grains, which support bone strength

3. Avoid smoking and excessive alcohol

Smoking reduces oestrogen levels, leading to faster bone loss. Quitting smoking can slow down the rate of bone thinning.

Excessive alcohol interferes with calcium absorption and increases the risk of falls, so drinking in moderation is recommended.

4. Consider hormone replacement therapy (HRT)

HRT is often the first-line treatment for osteoporosis prevention in menopausal women, particularly for those who experience early menopause. It helps maintain bone density by replacing lost oestrogen, reducing the risk of fractures.

HRT is not suitable for everyone, so it is important to discuss the benefits and risks with a doctor.

Why bone health matters

Osteoporosis is often called the silent disease because it develops without symptoms until a fracture occurs. The most common fractures occur in the hip, spine and wrist, leading to pain, reduced mobility and long-term health issues.

With one in two postmenopausal women expected to develop osteoporosis, taking action early is essential. By staying active, eating well, avoiding smoking and alcohol and considering medical options, women can protect their bones and reduce the risk of fractures as they age.

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