Your mother shrank a couple of inches in her later years. A friend broke her wrist after a simple fall on the sidewalk. Now that you are approaching or past menopause, you wonder what is happening to your own bones and whether you can still do something about it.

You can. After menopause, lower estrogen speeds up bone loss, so this is the time to protect your bones with enough calcium and vitamin D, regular weight-bearing and strength exercise, and a conversation with your doctor about bone density testing. Osteoporosis usually causes no symptoms until a bone breaks, which is why prevention and early testing matter so much.

Why menopause affects your bones

Bone is living tissue. Your body constantly breaks down old bone and builds new bone. Estrogen helps keep that process in balance.

When estrogen drops at menopause, bone breakdown starts to outpace bone building. The shift begins during the years of perimenopause, when estrogen levels start to swing and fall. According to the Office on Women’s Health, some women lose up to 25% of their bone mass in the first 10 years after menopause. Over time, bones can become thin and fragile. This is osteoporosis.

Who is at higher risk?

Your risk of osteoporosis is higher if you:

  • Are a woman past menopause, especially with early menopause
  • Have a family history of osteoporosis or hip fracture
  • Have a small, thin body frame
  • Smoke or drink a lot of alcohol
  • Don’t get enough calcium or vitamin D
  • Are not physically active
  • Take certain medicines long term, such as steroids

Many of these overlap with other midlife changes. If you are also dealing with fatigue or mood shifts, our guide to signs of hormonal imbalance can help you sort out what to bring up with your doctor.

Calcium and vitamin D: a team

Calcium is the main building block of bone. Vitamin D helps your body absorb calcium. If you don’t get enough vitamin D, the calcium you eat doesn’t do as much good.

How much do you need?

Nutrient Women 51 to 70 Women 71+
Calcium 1,200 mg/day 1,200 mg/day
Vitamin D 600 IU/day 800 IU/day

Calcium figures from the NIH Office of Dietary Supplements; vitamin D figures from the Office on Women’s Health.

Good food sources

  • Calcium: milk, yogurt, cheese, calcium-fortified plant milks and orange juice, canned sardines or salmon with bones, tofu made with calcium, and leafy greens such as kale and collard greens
  • Vitamin D: fatty fish such as salmon and tuna, egg yolks, and fortified milk and cereals. Your skin also makes vitamin D in sunlight.

Try to get most of your calcium from food. The Office on Women’s Health advises asking your doctor whether you need a calcium supplement, since more is not always better.

Exercise that builds bone

Bones respond to stress by getting stronger. Two types of exercise help most:

Weight-bearing exercise

Activities where your feet and legs carry your weight:

  • Brisk walking
  • Dancing
  • Climbing stairs
  • Low-impact aerobics
  • Hiking

Muscle-strengthening exercise

  • Lifting weights
  • Resistance bands
  • Body-weight exercises such as squats and wall push-ups
  • Yoga or Pilates (avoid deep forward bends and twists if you already have osteoporosis)

Balance training

Tai chi and simple balance drills help prevent falls, which is how most fractures happen.

If you already have osteoporosis, ask your doctor or a physical therapist which movements are safe for you.

Other ways to protect your bones

  • Don’t smoke. Smoking speeds up bone loss.
  • Limit alcohol. Heavy drinking weakens bones and raises fall risk.
  • Prevent falls at home. Remove loose rugs, add grab bars, and use night lights.
  • Ask about your medicines. Some drugs affect bone health.

Bone density testing

A bone density test (DXA scan) is a quick, painless X-ray that measures how strong your bones are. Talk to your doctor about when you should be tested, especially if you have risk factors or have broken a bone after a minor fall.

If your bones are thin, your doctor may suggest medicines that slow bone loss or help build bone. Hormone therapy can also protect bone, but it has risks that need to be weighed for each woman.

When to see a doctor

Talk to your doctor if:

  • You are past menopause and have never discussed bone health or testing
  • You broke a bone from a minor fall or bump
  • You have lost height or notice your back curving forward
  • You have sudden, severe back pain
  • You have risk factors such as early menopause, a family history of osteoporosis, or long-term steroid use

What else can help

Strong bones after menopause come from steady habits: enough calcium and vitamin D, regular weight-bearing and strength exercise, no smoking, and timely testing. Some women also look at supplements marketed for women’s health that include vitamin D or other nutrients. These are not a treatment for osteoporosis.

If you are comparing options, our FemiPro review looks at what it contains and what to weigh before buying. Talk to your doctor before adding any supplement, especially calcium or vitamin D, to make sure the total amount is right for you.