If you're in your mid 40’s or beyond, you're probably hearing a lot about menopause and its effects on sleep, mood, energy, metabolism and body composition changes.
But there's another important change happening during this stage of life that doesn't get nearly as much attention and that is: bone loss.
As estrogen levels decline during perimenopause and menopause, your bones can begin losing density at a faster rate. And because you can't feel your bones getting weaker, it's easy to overlook what's happening until a bone density scan reveals a problem or even worse you end up with a fracture.
The good news? There are practical steps you can take to support your bone health. Understanding what's happening is the first step.
Why does menopause affect bone density?
Your bones are living tissue. Throughout your life, your body is constantly breaking down old bone and replacing it with new bone. This process, called bone remodeling, helps maintain the strength and structure of your skeleton (bones).
Estrogen plays an important role in regulating this process. It helps keep bone breakdown in check, allowing your body to maintain a healthy balance between removing old bone and building new bone.
During perimenopause, estrogen levels fluctuate. After menopause, estrogen levels remain much lower. Without the protective effects of estrogen, bone breakdown begins to outpace bone building, leading to a loss of bone density.
This is one reason menopause is such an important window for bone health.
Bone loss accelerates during this menopausal transition and the first several years after your final menstrual period. Although the rate of loss generally slows over time, bone loss can continue as you age.
And while menopause is a major contributor, it's not the only factor that affects your bones. Genetics, body weight, nutrition, certain medications, medical conditions, and your history of physical activity all play a role.
How much bone density do women lose during menopause?
The amount varies from person to person. Some women experience relatively modest changes, while others lose bone more rapidly, particularly if they already have low bone density or additional risk factors.
This matters because the amount of bone you have going into menopause helps determine your bone health later in life.
Think of bone density as a reserve. The more bone mass you've built and maintained over the years, the more reserve you have as age-related and menopause-related bone loss occur. This is why I think it is so important to know your bone density sooner rather than later and that the earlier you start strength training, the better!
Although you can't change your genetics or turn back the clock, you can take steps to support the bone you have and reduce other factors that contribute to bone loss.
Why should you care about bone density?
Low bone density doesn't usually cause pain or any noticeable symptoms. You can be active, feel great, and have no idea that your bones are becoming weaker. I definitely didn’t know until I had my first bone scan at 58 years old and was diagnosed with osteopenia.
That's why bone health deserves attention even when you feel perfectly healthy and are active.
There are two terms you'll often hear:
Osteopenia: Bone density is lower than normal but not low enough to meet the bone density threshold for osteoporosis. (T-score between -1.0 and -2.5)
Osteoporosis: Increase in weakened bones and an increased risk of fractures. (T-score of -2.5 or lower)
Both conditions deserve attention, but neither means you should give up on improving your health or assume a fracture is inevitable.
Osteoporosis-related fractures most commonly affect the hip, spine, and wrist. Hip fractures can have a significant impact on independence and mobility, while spinal fractures can sometimes occur with little or no obvious injury.
The earlier you understand your bone health, the more time you have to make informed decisions about prevention and treatment.
5 ways to protect your bones during and after menopause
Here's where I want to focus….. What can you actually do?
Although you can't completely eliminate menopause-related bone loss, your daily habits can make a big difference in supporting your bones, maintaining muscle, and reducing your risk of falls and fractures.
1. Make strength training a priority
If there's one thing I want women in midlife to understand, it's this: strength training is about much more than building muscle. It's an investment in your long-term health, including your bones.
When you challenge your muscles against resistance, you also place mechanical stress on your bones. This signals your body to adapt and helps support bone strength.
A well-designed strength-training program should challenge the major muscle groups.
Think exercises such as:
Squats and sit-to-stands
Lunges and step-ups
Hip hinges and deadlift variations
Rows and other upper-body pulling exercises
Push-ups, overhead presses
The key is to progressively challenge your muscles rather than repeatedly doing the same easy workout without increasing the demand. It is recommended to do 2-3 full-body strength-training sessions per week.
You don't need to be afraid of lifting heavier weights. When appropriate for your current fitness level and bone health, gradually increasing resistance is an important part of getting stronger. This is called the overload principle and is very important in maintaining or building muscle and bone.
If you already have osteoporosis, a history of fractures, or significant back pain, your program should be tailored to your needs. A physical therapist or other qualified exercise professional can help you determine which exercises and loading strategies are appropriate for you.
2. Include weight-bearing and impact exercise
Walking is wonderful for your overall health, and I absolutely encourage it. But walking alone may not provide enough stimulus to maintain or improve bone density in all areas of the skeleton.
Your bones respond to the forces placed on them, so exercise variety matters.
Depending on your fitness level and health history, weight-bearing activities might include:
Brisk walking and hiking
Stair climbing
Dancing
Tennis or other court sports
Jumping, stomping, heel drops, depth jump. or other impact exercise, when appropriate
Impact exercise can be particularly useful for bone health, but it isn't suitable for everyone. If you have osteoporosis, a previous fragility fracture, joint problems, or other limitations, get guidance before adding jumping or other high-impact movements.
3. Eat enough calcium, vitamin D, and protein
Exercise is important, but your body also needs the proper nutrients to maintain bone and muscle.
Calcium is a major building block of bone. For women aged 51 and older, the general recommendation is 1,200 mg of calcium daily from food and supplements combined.
Calcium-rich foods include:
Calcium-fortified plant milks
Tofu
Canned salmon or sardines with bones
Yogurt. Cottage cheese, and milk, if tolerated
Certain leafy greens, such as kale and bok choy
My favorite whole food calcium supplement that I take daily is from Seen Nutrition. (Use code HILARY10 for 10% off first order)
Vitamin D helps your body absorb calcium. Your needs depend on factors such as your age, diet, sun exposure, and vitamin D status. Ask your healthcare provider whether you need a supplement and/or testing.
Protein is essential for maintaining muscle and supporting the structure of bone. Include a source of protein at meals, such as meat, chicken, fish, eggs, tofu, beans, lentils, or other foods that fit your preferences.
4. Talk with your healthcare provider about your bone health
A DEXA scan, also called a DXA scan, measures bone mineral density, usually at the hip and spine. It can help identify osteopenia or osteoporosis before a fracture occurs. Routine screening is recommended for women aged 65 and older.
However, younger peri-menopausal and postmenopausal women may also benefit from screening if their risk of osteoporosis is elevated. All you have to do is ask your healthcare provider whether a bone density assessment makes sense for you or ask them to write a prescription for you.
Factors that can increase risk include a family history of osteoporosis or hip fracture, a low body weight, previous fractures, smoking, certain medical conditions, and some medications.
If your scan shows low bone density, don't panic. Instead, use that information to develop a plan. Depending on your bone density score, fracture history, and overall risk, your plan may include exercise, nutrition, fall prevention, medication, or a combination of these approaches.
5. Understand the role of menopause hormone therapy
Estrogen plays an important role in bone health, so it's reasonable to wonder whether menopause hormone therapy (MHT), also called hormone replacement therapy (HRT), can help protect your bones.
The answer is yes: Research shows that systemic estrogen therapy helps prevent bone loss and reduces fracture risk while you're taking it.
For some women, bone protection is an additional benefit of hormone therapy prescribed for menopausal symptoms. It's also important to know that hormone therapy isn't the only option for protecting your bones. Medications specifically designed to treat osteoporosis can be highly effective and may be recommended when fracture risk is elevated.
If you've been diagnosed with osteoporosis, don't assume that exercise, calcium, vitamin D, or hormone therapy alone will provide enough protection. Discuss your individual fracture risk and treatment options with your healthcare provider.
What if you've already been diagnosed with osteopenia or osteoporosis?
First, take a breath. A diagnosis is information, not a reason to give up on the activities you love.
You can still work on building strength, improving balance, maintaining muscle, and supporting your overall health. Exercise is an important part of your treatment plan. However, the right approach depends on your individual circumstances.
If you have osteopenia, you may be able to focus on progressive strength training, appropriate weight-bearing activity, nutrition, and monitoring.
If you have osteoporosis, your plan may need additional precautions, particularly if you have a history of spinal fractures or other fragility fractures. Certain movements, including repeated or heavily loaded spinal rounding, may need to be modified.
And if medication has been recommended, remember that exercise and medication aren't necessarily competing approaches. For women at higher risk of fracture, combining appropriate exercise with effective medical treatment may provide better protection than relying on lifestyle changes alone.
The goal is to keep you strong, capable, and active for as long as possible.
Your bone health action plan: Start here
If you're wondering what to do first, here are five practical steps:
Review your strength-training routine. Are you challenging all your major muscle groups two to three times a week, with a plan to progress?
Look at your daily calcium intake. Estimate how much you're getting from food before automatically adding a supplement.
Make protein a priority. Include protein-rich foods throughout the day to support muscle and bone health.
Ask about your risk. Talk with your healthcare provider about whether you need a DEXA scan.
Keep moving. Find ways to incorporate weight-bearing activity, balance work, and movement you enjoy into your week.
Small, consistent habits add up. And if you already have low bone density, it's never too late to take steps to support your health.
The bottom line
Menopause is a significant turning point for bone health because declining estrogen levels can accelerate bone loss. But that doesn't mean weakened bones or fractures are an inevitable part of getting older.
Strength training, appropriate weight-bearing exercise, adequate nutrition, screening when indicated, and medical treatment when needed can all play a role in protecting your bones.
As women, we spend a lot of time thinking about how we feel today. I want us to think about how we want to feel 10, 20, and even 30 years from now, too.
I want to keep hiking, lifting weights, traveling, playing with my dog, and doing all the things that make life fun. Maintaining strong bones is part of helping me do that, and it's one of the reasons I encourage women in midlife to take their bone health seriously.
You don't have to wait for a diagnosis to start taking care of your bones. The best time to start is now.
If you're looking for a practical place to begin, download my FREE Menopause Bone Health Starter Guide. It's designed for women 40+ and covers the basics of strength training, impact exercise, nutrition, and balance to help you take the next step toward healthier bones.
How to Get Started with Strength Training Safely
If you’re new to weightlifting, start simple and build gradually. Full-body workouts a few times a week with basic moves like squats, lunges, push-ups, rows, and carries are enough to start seeing results. Focus on form, control, and consistency rather than lifting heavy from the start.
You can do it at home with dumbbells, bands, or just your bodyweight. And if you have any concerns, a physical therapist or trainer experienced with midlife women can make sure you’re progressing safely.
If you’re ready to get started, go check out my free Meno-Strength Sampler (also linked below). It’s beginner friendly, and gives you a full-body routine designed specifically for women in midlife and menopause. It takes out all the guess work and tells you exactly what to do so you can start feeling stronger without overcomplicating things.
Lifting weights during menopause isn’t about chasing a certain look. It’s about staying strong, protecting your bones, increasing your energy, and feeling empowered in your everyday life.
It can feel incredibly overwhelming to know where to start with strength training, especially if you don’t feel like you know what you’re doing when it comes to lifting weights and getting stronger.
Here are a few ways I can help you:
Get on the waitlist for my 1:1 Meno-Strength RX program: Personalized monthly fitness programming for women in menopause and midlife developed by a Doctor of Physical Therapy.
Empower Hour: 1:1 Coaching Session: This highly personalized session can be centered around a specific area that you need coaching on to help you meet your goals and answer any questions you have about menopause and strength training. You will leave this call with a newfound clarity and direction to help you move forward.
Grab my FREE Meno-Strength Sampler (just fill out the form below!): A look inside my Meno-Strength 8-Week program and a way for you to get started TODAY!
[FREE] Get access to my Meno-Strength™ Sampler Program
A FREE sample program that will get you started with strength training in midlife and menopause and beyond. Just type your first name and email below and it will be sent to you! Be sure to check your spam if you don’t receive it within a few minutes!
