BONE HEALTH

Menopause and Your Bones: Why Midlife Is the Time to Protect Your Skeleton

Hot flashes announce themselves. Bone loss doesn't. What shapes the skeleton you carry into midlife — and what protects it from here.

By Phillip Gallegos, MD
Physician and Co-founder, Thrive Medicine Clinic

When women think about perimenopause and menopause, hot flashes, sleep problems, mood changes, and weight gain often come to mind.

Bone loss usually doesn't.

But your bone-health story begins decades before menopause. The strength of the skeleton you bring into midlife has been influenced throughout your life by genetics, nutrition, physical activity, muscle strength, hormones, medications, and other health conditions.

Two of the most important factors are also things we can influence: how we fuel our bodies and how we use them.

Adequate protein, calcium, vitamin D, and other nutrients provide the building materials bones need. Resistance training, weight-bearing activity, and regular movement provide the physical stimulus that helps build and maintain strong bone and muscle.

Then menopause changes the equation.

Menopause can accelerate bone loss

Bone is living tissue. Throughout life, old bone is continually broken down and replaced with new bone.

Estrogen is an important regulator of this process. As estrogen begins to fluctuate during perimenopause and eventually declines, bone breakdown can begin to occur faster than bone formation. Women may lose bone particularly quickly during the years surrounding menopause.

And a major fracture later in life can be much more serious than simply “breaking a bone.” Hip fractures can require surgery and prolonged rehabilitation and may result in loss of mobility and independence. Among older adults who sustain a hip fracture, approximately 1 in 5 die within the following year.

That's why bone health should become part of the menopause conversation before osteoporosis develops—not after.

Bone is more than calcium

Most of us grew up hearing that strong bones require calcium. That's true, but it's only part of the story.

Bone contains a flexible framework made largely from collagen, a type of protein. Minerals are deposited onto this framework to provide strength and structure.

Protein also helps preserve muscle—another critical part of maintaining strength, balance, mobility, and independence as we age.

Calcium and vitamin D remain important, along with nutrients such as magnesium, vitamin K, and phosphorus. Think of nutrition as providing the raw materials your body needs to maintain bone and muscle.

Give your bones a reason to stay strong

If nutrition provides the materials, exercise provides the signal.

Bones respond to physical stress. Progressive resistance training and appropriate weight-bearing exercise encourage the body to maintain stronger bones and muscles.

Muscle strength and balance also help protect your skeleton by reducing fall risk. Bone and muscle health should therefore be thought of together—not as separate parts of healthy aging.

Where does hormone therapy fit?

Because declining estrogen accelerates bone breakdown, menopausal hormone therapy can prevent bone loss and reduce fracture risk in appropriately selected women.

That doesn't mean hormone therapy is right for every woman. The decision should consider symptoms, age, medical history, individual risks, whether a woman has a uterus, and the type, dose, and delivery method of the hormones being considered.

But protecting bone is an important potential benefit that deserves to be included in the hormone-therapy conversation.

Don't forget your thyroid

Too much thyroid hormone—whether from an overactive thyroid or more thyroid medication than the body needs—can increase bone turnover and contribute to bone loss. Women taking thyroid medication should have their treatment appropriately monitored, particularly as they move through menopause or if osteoporosis risk increases.

Know where you stand

Because bone loss is usually silent, testing can help identify risk.

DXA (often called DEXA) is the standard X-ray-based test for measuring bone mineral density. REMS, or Radiofrequency Echographic Multi Spectrometry, is a radiation-free ultrasound-based technology that can also assess bone density and skeletal fragility.

A test result is only part of the picture. Family history, previous fractures, menopause timing, medications, nutrition, exercise, muscle health, thyroid health, and other medical conditions all matter.

Build the body you'll need later

Menopause isn't simply about managing symptoms today. It's an opportunity to protect the body you'll depend on decades from now.

Feed your bones. Challenge them. Build and preserve muscle. Understand your hormones. Know your risk.

Your bones are living tissue—and what you do throughout life, especially during this important transition, can help determine how well they support you for the rest of it.

Learn more about services offered by Thrive Medicine Clinic→

The short version

Estrogen helps keep bone breakdown and bone formation in balance. As it declines through perimenopause and menopause, breakdown can outpace formation, and bone can be lost quickly during the years surrounding the transition — usually silently, sometimes until a fracture. Nutrition supplies the materials, and that means protein and collagen as much as calcium and vitamin D. Exercise supplies the signal: progressive resistance and weight-bearing work, which also builds the muscle and balance that help prevent falls. Hormone therapy can prevent bone loss in appropriately selected women, thyroid medication should be monitored, and DXA or REMS testing can show where you actually stand. The time to act is before osteoporosis develops.

This article is general education, not medical advice. Talk with a qualified healthcare provider about your own health.

Dr. Gallegos is co-founder of Thrive Medicine Clinic, which provides hormone therapy. Thrive Medicine Clinic is a sponsor of Second Spring.