How Menopause Affects Bone

Bone is continuously remodelled by osteoclasts (bone resorption) and osteoblasts (bone formation). Oestrogen normally suppresses osteoclast activity; when levels fall, bone breakdown accelerates and women may lose 1–3% of bone mineral density each year during the first five years after menopause.

Who Is at Higher Risk?

• Early menopause or premature ovarian insufficiency
• Family history of hip fracture or osteoporosis
• Low body weight (BMI below 20)
• Smoking and excessive alcohol intake
• Long-term corticosteroid therapy
• Malabsorption, rheumatoid arthritis or kidney disease
• Falls risk due to poor vision, medications or balance problems

Diagnosis & Screening

• FRAX calculator estimates 10-year fracture risk
• DXA scan is the gold standard for bone density measurement
• T-score between −1.0 and −2.5 indicates osteopenia
• T-score of −2.5 or below confirms osteoporosis
• Vertebral fracture assessment may identify silent spinal fractures

Bone Protection Strategies

• Hormone Replacement Therapy for eligible menopausal women
• 700–1200 mg calcium daily from diet or supplements
• 800–1000 IU vitamin D daily for optimal calcium absorption
• Weight-bearing and resistance exercises
• Balance training, vision correction and fall prevention measures

Pharmacological Management

Women with established osteoporosis or a high fracture risk benefit from evidence-based medication. Bisphosphonates such as alendronate, risedronate and zoledronate remain first-line therapies and reduce fracture risk by 40–70%. Denosumab provides an effective six-monthly injectable alternative, while romosozumab and teriparatide are reserved for severe osteoporosis requiring bone-building therapy.