What’s the connection between menopause and osterporosis, and how can you protecting your bones in midlife? Here’s our guide...

What do you think of when you hear the word ‘osteoporosis’? You might have an image of a frail elderly person with weakened bones that break easily. While many older people do suffer from osteoporosis, changes in our bone strength start far earlier in life that most of us realise – in our late thirties. 

And, for women, that strength diminishes even more rapidly once we are the other side of menopause; according to the NHS, women lose 20 per cent of their bone density in the five to seven years after menopause. We wanted to know why this happens and what we can do to protect our bones as we move into and beyond menopause.

What causes osteoporosis?

Osteoporosis is now a global disease that affects an estimated 200 million people worldwide. It’s all down to bone density (the amount of bone tissue that your body makes and repairs) and how strong that bone tissue is. While there are some things, known as risk factors, that you can control or change to support your bone health, there are some that you can’t.  As the Royal Osteoporosis Society explains, the risk factors that you can do something about are:

  • low body weight – less bone tissue and, when you’re older, less body padding to cushion falls
  • smoking
  • too much alcohol
  • frequent falls caused by poor co-ordination and balance

The things you can’t change are:

  • genes - if you have a family history  of osteoporosis
  • age – bone strength decreases as we get older, irrespective of bone density, and we are more likely to have falls 
  • being a woman – oestrogen levels, which support bone strength, drop during and after menopause 
  • Asian or Caucasian heritage – you’re less at risk of broken bones is you are of Afro-Caribbean heritage
  • broken bones or fractures in the past – just one break increases your risk of two or more in the future

Medication, such as aromatase inhibitors - used to treat some types of breast cancer - can affect bone strength too. You can find a full list here on the Royal Osteoporosis Society website. Chemotherapy may have a similar effect and if your breast cancer is hormone related, you will probably have regular DEXA scans (see below) to monitor any changes in your bone density.

How is osteoporosis diagnosed?

If your doctor thinks that you are at risk of osteoporosis, they will arrange for you to have a special type of x-ray, known as a DEXA scan, to measure your bone density. 

If you are given a diagnosis of osteoporosis, it means that your bones could break easily; if you are diagnosed with osteopoenia, your bones are weaker than normal but are not yet at risk of breaking.

You can find out more about osteoporosis, osteopoenia and how they are diagnosed here.

What happens if I have osteoporosis or osteopoenia?

If you are diagnosed with either condition, your GP will recommend medication, such as bisphosphonate tablets for osteoporosis, to strengthen your bones. You can read more about different types of treatment, including benefits and risks, here.

What can I do to support my bone health during perimenopause, menopause and beyond?

It’s a good idea to put a bone health and strength protection plan in place as you move towards and into menopausebut, even if you have already been diagnosed with osteoporosis or osteopoenia, there are things to avoid and things you can do that can make a difference.


Stop smoking 

Ask your GP for help with this if you are finding it hard to stop.


Watch your alcohol intake 

Avoid binge drinking and don’t exceed the current NHS guidelines of 14 units a week. If you’ve got into the habit of drinking daily, try to have one or two alcohol-free days each week. Better still, think of alcohol like cake – something best kept for special occasions!


Take regular exercise several times a week 

Include weight-bearing and resistance exercises and don’t forget that brisk walking is excellent exercise too. Yoga and Pilates can help with co-ordination, balance and flexibility, and Pilates is develops core strength, which supports your entire body.


Eat a healthy, balanced diet and aim for a healthy (not low) body weight 

Make sure you eat plenty of calcium-rich foods including dried fruit, green vegetables, tofu and yogurt.

For help with healthy eating during menopause, we recommend The Midlife Kitchen: Health-boosting recipes for midlife & beyond by Mimi Spencer and Sam Rice.

What’s the connection between Vitamin D and osteoporosis?

Although we talk about Vitamin D, it’s actually a hormone and vital for bone strength and health. A daily dose of sunshine is great but, in cooler countries with fewer sunny days, we simply can’t get enough Vitamin D, especially in its crucial form of cholecalciferol (Vitamin D3), from sunshine alone. So, try to include these Vitamin D-rich foods in your diet: egg yolks, fortified breakfast cereals (but avoid any with high sugar levels), fortified plant milks such as almond,  liver, mushrooms, red meat (two portions a week but avoid smoked meats), oily fish such as sardines (ideally with their bones) and tofu. 

Think about a Vitamin D supplement – even if you are able to get out into the sunshine regularly and you are eating for good bone health, your Vitamin D levels still might not be at the optimum level. The NHS suggests a daily does of at least 10 micrograms (that’s 400 IU – International Units). 

Some medical experts recommend much higher dosages and suggest that Vitamin D supplements works best when combined with Vitamin K2, so we advise that you check with your GP or other appropriate healthcare professional to see what they recommend for you.

Live Better With offers a range of Vitamin D3 supplements at different strengths including 1000 IU, 4000 IU and a Vitamin D3 and K2 combination.

Where can I find out more about osteoporosis?

The Royal Osteoporosis Society (formerly the National Osteoporosis Society) is an excellent resource both online and through local support groups. HRH The Duchess of Cornwall has been a supporter since 1997 and president since 2001, following the deaths of her mother and grandmother as a result of the condition.

The society offers information, advice and support on all aspects of osteoporosis, its treatment and prevention, including exercise and diet. It has a free osteoporosis helpline and can put you in touch with your local support group.

You can read current NHS guidelines on osteoporosis causes, treatment and prevention, and living with osteoporosis, here.

By Diane Trembath


Have you been diagnosed with osteopoenia or osteoporosis before, during or after menopause? If so, do let us know how it has affected you and what has helped.

Join the Live Better With Menopause Community Forum to post your questions or share advice, information and tips.