BONE HEALTH
Why menopause is a bone health event
Bone density can drop fastest in the years right after your last period. What a DEXA scan tells you, and when to get one.
Second Spring editorial
Most of what changes at menopause announces itself. Hot flashes are hard to ignore. Sleep either comes or it doesn't. Your cycle tells you plainly that something is different.
Bone is the exception. It changes faster during this stage than at any other point in adult life, and it usually does so quietly — which is why it's the one thing worth checking on before anything goes wrong.
What happens to bone at menopause
Estrogen helps regulate the cells that break down bone. When estrogen drops, that balance tips, and bone is lost faster than it's replaced. The Bone Health & Osteoporosis Foundation reports that a woman can lose up to 20% of her bone density in the five to seven years following menopause.
The Cleveland Clinic describes the same pattern and notes that this loss raises the risk of osteopenia and osteoporosis. Rates vary considerably from woman to woman — which is part of why knowing your own number is more useful than knowing the average.
It's usually quiet, which is the problem
In its early stages, bone loss typically gives you very little to go on. There's no reliable ache that signals thinning bone, and for many women the first clear indication is a fracture — often from a fall that wouldn't have broken anything a decade earlier. The National Institute on Aging lists osteoporosis among the conditions women become more vulnerable to after menopause, alongside heart disease and stroke.
That doesn't mean bone loss never produces symptoms. As it advances, small compression fractures in the spine can cause back pain, gradual height loss, or a stooped posture, and those changes sometimes appear before anyone has connected them to bone. Persistent back pain in midlife is worth raising with a clinician rather than filing under general wear and tear.
But by the time bone is announcing itself, you've usually lost ground you'd rather have kept. Which is the whole argument for measuring rather than waiting.
Two ways to measure: DEXA and REMS
A DEXA scan (dual-energy X-ray absorptiometry) measures bone mineral density, usually at the hip and spine. It takes a few minutes, and it uses a low dose of radiation. The U.S. Preventive Services Task Force notes that DEXA is the most commonly used bone density test, that it correlates with bone strength and fracture outcomes, and that it was the test used in nearly all the major trials of bone-preserving medications. It remains the reference standard that screening guidelines are written around.
REMS — radiofrequency echographic multispectrometry — is a newer, ultrasound-based method that measures the same sites without any radiation at all. A 2024 review in Aging Clinical and Experimental Research describes REMS as a radiation-free, portable technology for assessing and monitoring osteoporosis at the lumbar spine and femoral neck, with a growing body of research showing strong correlation with DEXA measurements. A multicenter study of 1,914 postmenopausal women found good agreement between the two.
Two things make REMS worth knowing about. It produces a Fragility Score alongside the density number — a measure of bone quality and structural integrity, which DEXA alone doesn't capture, and which a 2025 systematic review found distinguished between people who had fractured and people who hadn't. And because there's no ionizing radiation, it can be repeated more often and used in people for whom DEXA isn't suitable.
That last point matters more than it sounds. If measuring your bone carries no radiation cost, there's much less reason to ration how often you do it or to wait until you're older to start.
Either scan reports a T-score comparing your density to a healthy young adult reference. A score of −2.5 or lower at the hip or spine meets the definition of osteoporosis. Between that and normal sits osteopenia — lower than ideal, not yet osteoporosis, and generally the point at which it's most worth acting.
Availability differs. DEXA is widely available and generally covered by insurance when screening criteria are met; REMS is offered at a smaller number of sites, so it's worth asking what's near you and what each will cost.
The case for going sooner rather than later
The U.S. Preventive Services Task Force recommends screening for osteoporosis in all women aged 65 and older, and in postmenopausal women younger than 65 who are at increased risk of an osteoporotic fracture.
Sixty-five is a floor, not a target. If the steepest losses happen in the five to seven years after your last period, waiting until 65 can mean your first measurement arrives after the fastest decline has already happened. A number taken earlier tells you where you started; a number taken later only tells you where you ended up.
Factors that put you in the earlier group include a family history of osteoporosis or hip fracture, low body weight, a previous fracture as an adult, smoking, long-term steroid use, rheumatoid arthritis, and menopause before 45 — whether it happened naturally or after surgery to remove the ovaries. If any apply, that's a conversation to have now.
There's also a reason many American women may be starting from behind. The NIH Office of Dietary Supplements reports that most people in the United States consume less vitamin D than recommended — women average roughly 168 IU a day from food and drink, against a recommended dietary allowance of 600 IU for most adults — and that more than 53 million US adults have osteoporosis or are at risk of developing it.
Calcium intakes fall short too, particularly among older adults and lower-income households, according to the NIH Office of Dietary Supplements.
None of that tells you about your own bones. It's an argument for finding out rather than assuming you're fine.
What helps
The National Institute on Aging advises continuing to eat a healthy diet, staying active, and getting enough calcium and vitamin D for optimal bone health after menopause. Weight-bearing and muscle-strengthening exercise, not smoking, and moderate alcohol use all support bone as well.
Where bone density is already low, there are medications that reduce fracture risk, and hormone therapy prevents postmenopausal bone loss in some women. Those are decisions for you and your clinician, based on your scan, your risk, and your health history — not something to sort out from an article.
What to ask
-
Based on my history, should I have a baseline DEXA scan now rather than at 65?
-
Do any of my risk factors change that answer?
-
Is REMS available near me, and would it be a reasonable option given how often I'd want to re-measure?
-
If I've already had a scan, what was my T-score, and how does it compare to last time?
-
Am I getting enough calcium and vitamin D, and how would we know?
-
What kind of exercise would actually help my bones, given where I'm starting?
The short version
Bone loss accelerates around menopause and can reach up to 20% of density in the years that follow, usually with little warning until something breaks. DEXA is the established scan; REMS measures the same sites without radiation and adds a bone quality score. Screening is recommended for everyone at 65 and earlier for those at increased risk — but the most useful measurement is the one taken before the steepest losses, not after.
This article is general education, not medical advice, and is not a substitute for diagnosis or treatment from a qualified clinician. Talk with your own healthcare provider about your health.
Sources
Bone Health & Osteoporosis Foundation — What Women Need to Know — Up to 20% of bone density lost in the five to seven years after menopause
U.S. Preventive Services Task Force — Osteoporosis screening — Screening recommendations, DEXA as the standard test, risk-based screening under 65
National Institute on Aging — What Is Menopause? — Osteoporosis risk after menopause; diet, activity, calcium and vitamin D
Cleveland Clinic — Osteoporosis and menopause — Estrogen loss, rate of bone density decline, osteopenia and osteoporosis risk
Aging Clinical and Experimental Research — REMS: state of the art (2024) — REMS as a radiation-free method for assessing and monitoring bone at the spine and femoral neck
Multicenter REMS vs DEXA accuracy study — Good agreement between REMS and DEXA in 1,914 postmenopausal women
Systematic review of REMS and fragility fracture prediction (2025) — Fragility Score distinguished fractured from non-fractured patients
NIH Office of Dietary Supplements — Vitamin D — US intakes below recommended levels; 53 million adults with or at risk of osteoporosis
NIH Office of Dietary Supplements — Calcium — Shortfalls in US calcium intake, particularly older and lower-income adults