Your Bones During Menopause

When we talk about menopause, symptoms like hot flashes, night sweats, and vaginal dryness often take center stage. But there's one major health concern that deserves just as much attention: your bones.

Bone health might not be something you can see or feel every day — until there’s a problem. And by then, it’s often too late. That’s why understanding what happens to your bones during menopause is so critical.

The Importance of Bone Health During Menopause

As we age, our bodies undergo significant changes. One crucial aspect is bone health. The loss of bone density during menopause can lead to severe issues down the line. Strong bones are vital for mobility and overall health. Taking preventive measures is essential during this phase of life.

Estrogen and Bone: The Hidden Connection

Estrogen isn't just about reproductive health. It has a powerful influence on bone remodeling — the constant process of breaking down and rebuilding bone tissue. When estrogen levels decline during the menopause transition, bone resorption (breakdown) begins to outpace formation. The result? Bone loss that can lead to osteopenia or osteoporosis.

Here’s the kicker: the most dramatic bone loss happens during the menopause transition, often before your final period. That’s why it's so important to start thinking about bone health early — not years after menopause has started.

Defining the Basics: Osteopenia, Osteoporosis, and Bone Quality

You’ve probably heard of bone density, but not all bone loss is visible on a DEXA scan. Bone quality — which includes structure, strength, and turnover — also matters. Even women with "normal" bone density can have fragile bones if bone quality is compromised.

Doctors use T-scores and Z-scores from DEXA scans to assess your risk:

• T-score: Compares your bone density to that of a healthy young adult.

• Z-score: Compares it to what's typical for your age and sex.

  
  

Another tool, FRAX, calculates your 10-year risk of fracture based on factors like age, weight, and personal history.

What You Can Do — Before and After Menopause

Bone mass peaks in your late 20s to early 30s. From there, the goal is maintenance. Once estrogen declines, maintenance turns into damage control. Here’s how to protect your bones:

• Maximize bone mass before menopause through strength training, calcium/vitamin D, and avoiding smoking.

• Estrogen therapy (MHT) is the only treatment that prevents bone loss and also builds bone in postmenopausal women.

• Exercise is helpful, but not enough — especially once hormone levels drop.

• Hot flashes matter — women with more severe vasomotor symptoms tend to have lower bone density. It’s not just a comfort issue — it’s a risk factor.

  
  

Menopause Hormone Therapy and Bones (MHT)

Many women don’t realize how directly MHT affects bone. Here’s what the data shows:

• Estrogen prevents bone loss and reduces fracture risk, even in women without hot flashes.

• Once you stop estrogen therapy, you lose the bone you gained. The protective effect does not last indefinitely.

• Type and dose matter: Conjugated estrogens, as well as transdermal and oral 17-beta-estradiol options all work, but adequate dosing is essential to preserve bone.

• Progesterone may support bone health, but the evidence is less clear than for estrogen.

• Testosterone, when used appropriately in women with low levels, may have a small positive effect on bone.

  
  

Beyond Estrogen: Other Options

Not all women can or want to take estrogen. For high-risk patients or those with severe osteoporosis, anabolic agents like teriparatide or romosozumab may be appropriate — these build bone, rather than just slow loss.

Bazodoxifene, a SERM found in Duavee™, combines estrogen with a compound that protects the uterus and supports bone — a great option for some women in early menopause.

Should You Stay on MHT Forever?

Not necessarily. But for women who are otherwise good candidates, long-term hormone therapy is a powerful tool to preserve bone health. The key is individualized care — balancing risks, benefits, and personal preferences.

The Role of Lifestyle Factors

Lifestyle choices play a significant role in maintaining bone health. Regular weight-bearing exercises strengthen bones and improve balance. A balanced diet rich in calcium and vitamin D supports bone density. Avoiding smoking and limiting alcohol intake also contribute to healthier bones. The earlier you incorporate these habits into your life, the better the outcome for your bone health during menopause.

The Bottom Line

Bone loss during menopause is real, measurable, and — for many women — preventable. Whether or not you choose MHT, the earlier you understand your risk and your options, the better your outcomes.

If you’re in midlife and haven’t had a conversation with your doctor about your bones, now’s the time. Taking proactive steps can help mitigate bone loss and support your overall health.