Being told your bones need watching after menopause can feel like one more thing to monitor, without much sense of what it actually means day to day. The risk of osteoporosis around menopause is real. Oestrogen helps keep your bones strong, and when it drops during menopause, bone loss speeds up. Because that loss is silent, with no pain and no early warning, understanding what is happening in your skeleton, and what you can do about it, is worth your attention now rather than after a fracture.4
Why oestrogen matters for bone health
Throughout your life, your bones are constantly broken down and rebuilt, and oestrogen helps keep that cycle in balance. When oestrogen falls at menopause, the balance tips, and bone is broken down faster than your body replaces it. Over time this shows up as a gradual loss of bone density, which can progress to osteoporosis without support.5
In its early stages, osteoporosis gives you nothing to feel. The first sign is often a broken bone, usually in the wrist, hip, or spine, that happens more easily than it should. Around half of women over 50 will break a bone because of it. That is why getting a sense of your own risk before a fracture happens is worth doing.1
Risk factors beyond menopause itself
Menopause is the most common reason bone density starts to drop, though it is not the only thing that matters. Your risk may be higher if any of these apply to you:
- A family history of osteoporosis
- Long-term use of high-dose steroids (speak to your GP before making any changes to a prescribed medicine)
- A low body mass index (BMI)
- Low levels of physical activity
- Heavy alcohol use or smoking
- Early menopause (before age 45)2
If your periods stopped before age 45, your bones will have spent less time with oestrogen's protective effect. In that situation, hormone therapy to support your bones until around the average age of menopause, which is 51, is something a GP or specialist may raise with you. It is a conversation to have with a clinician rather than a decision to make on your own.6
How bone testing works and what the results mean
If your GP feels your fracture risk needs a closer look, they will use a clinical tool, FRAX or QFracture, to estimate your chance of a fracture over the next ten years. These are tools a GP works through with you during an appointment, rather than something you fill in yourself. If the result points to a higher risk, you may be referred for a bone density scan, known as a DEXA (or DXA) scan.37
A DEXA scan measures your bone mineral density and gives a result called a T-score. That figure compares your bone density to a healthy young adult. A T-score of -2.5 or below points to osteoporosis. A score between -1 and -2.5 is called osteopenia, which means your bone density is lower than average but has not reached osteoporosis. A healthcare professional reads your T-score alongside your other risk factors, because the number on its own does not tell the full story.8
Everyday steps that support your bones
Wherever your bone density sits right now, several steps are within your control and have good evidence behind them for supporting your bones.
Exercise: weight-bearing and resistance work
Weight-bearing activities like brisk walking, jogging, and dancing, along with muscle-strengthening work such as lifting weights or resistance training, both help maintain and build bone density. If you have an osteoporosis diagnosis, it is worth speaking to your GP or a physiotherapist before you start something new, so the activity fits your current bone strength and keeps fracture risk down.10
Calcium through food
Adults need around 700mg of calcium a day for bone health. Dairy, leafy green vegetables, and tofu are all good sources. A varied diet can usually reach this without supplements, though your own needs after menopause are worth talking through with your GP, since some people need more.11
Vitamin D for calcium absorption
Your body needs vitamin D to absorb calcium properly. In the UK, sunlight alone does not give you enough through autumn and winter. Public health guidance suggests all adults consider a daily supplement of 10 micrograms (µg) of vitamin D, especially over those colder months.12
Smoking and alcohol
Smoking and heavy drinking both work against your bones. Stopping smoking and keeping alcohol within the general low-risk guideline of no more than 14 units a week are among the steps that help protect them. That 14-unit figure is a general adult health guideline rather than a bone-specific allowance.13
If you want to understand more about bone health testing or fracture risk, your next GP appointment is a good place to raise it, and they can point you towards reliable bone health information and support.