Does Menopause Cause Bone Loss

February 25, 2025 Dr. Anna Cabeca

One question I get a lot from my Girlfriend Doctor Community is about what women can do to prevent osteoporosis, the degenerative bone loss, and weakening which increases the risk for fracture. This question comes from women of all ages, whether they are in their 30s, in menopause, or postmenopausal.

It is estimated that about 18.8 percent of women over the age of 50 have osteoporosis (even if not formally diagnosed), and probably some 80 percent have at least some measurable bone loss by that age. (CDC data 2017-2018) (48)

The good news is there is a lot women can do—at any age—to prevent, delay, and even reverse bone loss.

First, though, we need to understand why we start to lose bone and bone strength to begin with.

Osteoporosis is a degenerative bone disease. It initially appears as lower bone mineral density (less bone) in women starting around the age of 35. Family history as well as a wide variety of lifestyle influences (smoking, diet, exercise, etc.), hormone imbalances (estrogen loss being key), stress, and other risk factors can influence the speed of a given woman’s bone loss.

Menopause in particular can have a tremendous impact on the development and worsening of osteoporosis.

Osteoporosis progression can be treated and substantially delayed, or even avoided, in many cases, if you take the right preventative steps. The challenge is that it is a “silent” disease; there are really no symptoms prior to sustaining an initial fracture.

But none of us want broken bones! That’s why preventative bone density screening and other bone health testing is so important. I’ll talk about three recommended bone health tests later on in this article.

You may not be aware of this but the bone in your body continually breaks down (a process called resorption) and is replaced by new bone (called formation). Both of these processes result in “bone turnover”. When you are younger your body makes more bone than it breaks down so bone density increases or remains the same (and bone turnover isn’t on the increase).

But by your mid-30s, although your body continues to break down and build new bone, it rebuilds bone at a slower pace. Bone turnover increases. This is when we start to see a decrease in bone mass (measured as bone density), abnormal bone structure, and a reduction in bone quality and strength. If screened, a woman may find out she has normal bone density or she may be diagnosed with osteopenia (lower bone density than normal), which means her screening scores show her bone density is actually already progressing to osteoporosis (and a significantly increased risk for fractures).

I’ll talk much more about this but menopause has a significant impact on bone density and overall bone quality. Bone loss has been found to be most rapid during the period right before, during, and after menopause.

Statistics vary but according to the National Institute on Aging, one out of every 2 women and 1 in 4 men over age 50 will have an osteoporosis-caused fracture (most typically of the hip, spine, or wrist) in their lifetime. (1)

What Does Bone Loss Look Like?

Your bones are not solid, stiff, and unchanging like a Halloween skeleton! Your bones are actually alive and growing, flexible, and even have flowing body fluids inside of them.

Think of bone as a porous matrix, almost like a honeycomb. That matrix is made up of protein, collagen, and minerals such as calcium. The structure provides bone strength and in particular, calcium keeps our bones strong. The collagen inside our bones provides flexibility and helps absorb shock when we run or are active; it helps keep bone from breaking. We want hard but flexible bones!

Credit to: https://www.researchgate.net/publication/266487959_Intelligent_Predictive_Osteoporosis_System

Osteoporosis actually means “porous bone.” See how it looks under a microscope? The bones showing osteoporosis have an abnormal and thin tissue structure and have lost density or mass. Bones become more porous, brittle, and less flexible. This makes them weaker and more likely to break.

Risk Factors for Osteoporosis (do you know your risk?)

There are many things you can do to prevent or delay osteoporosis progression but there are some key risk factors that you may not be able to change. The good news is that knowing about your unique set of risk factors early on should alert you and your doctor to the potential need for earlier bone density and bone quality screening—and makes it more likely to get insurance to cover that screening as well.

Risk factors that you can’t really control (but that can provide a heads-up on your increased risk for osteoporosis) include :

Your age

osteoporosis risk increases with age, especially over 50.

Your sex

while men do get osteoporosis a woman’s risk is 4 times greater. (2)

Genetics

a family history of bone loss, osteoporosis, or fractures. A parent having height loss or curvature of the spine.

Factors occurring during childhood and adolescence

such as poor nutrition, low calcium intake, and delayed puberty. (3)

Ethnicity

some research has found that white, Hispanic, Asian, and Native American women are more at risk for osteoporosis than black women. (4,5)

Irregular Periods/amenorrhea/ovulatory issues

some research has found that white, Hispanic, Asian, and Native American women are more at risk for osteoporosis than black women. (4,5)

Early Menopause

the decrease in sexual hormones results in greater bone loss (I’ll talk more about this in a moment).

Low body mass index (BMI)

having a small body frame size, or being underweight. (7)

Pregnancy and breastfeeding

can cause a temporary decrease in bone density.

Previous surgery to remove ovaries

prior to menstruation stopping naturally (ovaries produce estrogen). Note that even a hysterectomy without removal of the ovaries can increase a woman’s osteoporosis risk as research has found that women will often transition to menopause earlier after a hysterectomy. (8)

History of a broken bone after age 50

can be a warning sign of osteoporosis, as it may indicate reduced bone density and strength. As we age, bones naturally become more fragile, and even a minor fall or impact can lead to fractures, signaling an increased risk for future bone breaks.