Your bones are made of living tissue that comes and goes as the bone grows, repairs itself, and decreases. The amount of bone tissue you have dictates how strong the bones are. Dense bone tissue equals strong, healthy bones.
Around the time of menopause, our bones lose tissue faster than they can regrow new tissue, so the overall effect is a loss of bone density and therefore our bones get weaker. The weaker they are, the more likely they are to break.
Bones begin to lose their density by our late thirties, but at menopause this process speeds up because estrogen has been the key hormone protecting and keeping your bones strong but now it’s in short supply. This is why women get more hip, wrist and vertebral fractures and have the bone weakening condition, osteoporosis, more than their male counterparts.
There’s lots you can do to reduce the effects of bone loss and minimise the weakening process through the right kind of exercise and having adequate levels of calcium, vitamin D and other important nutrients in your diet.
Bone strength matters
Along with changes to your heart health, bone loss is one of the primary health conditions exacerbated by menopause but we often don’t think about our bone health until something goes wrong, like an accident and we break a bone.
One in three women over 50 will break a bone. Some fractures, like the hip for example, have devastating effects on your mobility, your ability to carry out everyday tasks, and your overall health. And once you break a bone, it makes you more likely to sustain another fracture within the following year.
It’s really important that we understand the changes happening to our bones around menopause and know how to minimise bone loss through diet and exercise, and through taking HRT if you choose.
What is osteoporosis?
Osteoporosis is a condition that is diagnosed when there has been significant bone loss and the risk of breaking the bone is higher than average. It takes years of bone loss to reach the point of osteoporosis, but most people don’t realise their bones are weakening (as there’s usually no symptoms) until they break a bone and have an x-ray or scan[SB2] .
You’re more likely to develop osteoporosis if relatives have it, but you’re also at risk if you smoke, you drink more than the recommended limits of alcohol, you take certain medications such as steroids, have some medical conditions such as rheumatoid arthritis, or you are menopausal (or postmenopausal) and don’t take HRT.
If you think you’re at risk of developing osteoporosis, you can see your doctor and ask for a FRAX or Q-Fracture assessment. This will ascertain your individual level of risk. You may be referred for blood tests or a scan called DEXA (or DXA) to assess the quality of your bones.
You can read more about tests and scans from the Royal Osteoporosis Society’s guide theros.org.uk
Treatment for osteoporosis in post/menopausal women usually involves the diet and lifestyle advice described here and HRT is often recommended to top up estrogen levels and slow down the bone-weakening process. HRT is also considered to prevent osteoporosis occurring in women below the age of 60, if they have a higher risk of this. For women with established osteoporosis, other medications known as bisphosphonates are often advised to treat the condition.
How do I keep my bones strong and healthy?
The good news is we can really make a difference to the strength and health of our bones using these four strategies alongside each other:
- Take HRT: topping up your estrogen levels will slow down the bone-weakening process and HRT is as effective at reducing bone loss as than any other medication for osteoporosis. If you are diagnosed with this condition, you can use a DEXA scan to measure your bone density and monitor change once estrogen treatment has begun, to see if you’re on an adequate dose and that your body is absorbing it well enough to help your bones in the long term.
- Eat plenty of bone strengthening nutrients: as well as following the principles of a Mediterranean diet, try and eat plenty of calcium rich foods like cheese, yoghurt and milk but also green leafy vegetables, nuts and seeds, dried fruit and the soft bones in tinned fish. If you avoid dairy products in your diet, you may need to consider a calcium supplement if your dietary intake falls below recommended levels (700-1200mg daily).You can use this dietary calcium calculator to find out how much calcium you’re having.Vitamin D helps slow down bone loss too and helps your body absorb calcium. Foods high in vitamin D are oily fish, egg yolks, and some fortified cereals and bread. But our body mostly makes vitamin D from sun exposure, so taking it as a supplement is recommended, ideally all year round in the UK, but especially from October to April. Iron is needed for bone health too and that doesn’t just mean eating red meat. You can get iron from spinach, broccoli, kale, lentils, chickpeas, kidney beans, cashews, and baked potatoes for example. Eating a healthy diet will also help your weight stay in a healthy range, as being under- or overweight increases your risk of osteoporosis.
- Do the right type of exercise regularly: we know it’s good to do exercise that gets us breathing faster and the blood pumping (aerobic exercise) and this is good for overall health and fitness. For our bone health, we need to add in physical activities involving movement that bears our own weight, impacts through the joints, and strengthens the muscles.Most exercise is weight-bearing, unless you’re swimming, cycling or doing it lying down or sitting. Low impact activities are walking and climbing stairs, more moderate impacts are jumping, dancing, jogging, and racket sports, and high impact are sports like netball, volleyball, or doing star jumps. The Royal Osteoporosis Society recommends about 50 moderate impacts on most days if you’re well, and also for most people with osteoporosis, but this could simply be jumping, skipping, jogging or hopping.When your muscles pull on your bones it gives your bones work to do. Your bones respond by renewing themselves and maintaining or improving their strength. To strengthen your bones, you need to strengthen your muscles too. And you do this by moving them against resistance such as lifting weights or pushing against something, using a resistance band, or using your own body weight like during a press-up. These are all muscle strengthening activities. Aim to do this type of exercise 2-3 days each week, on non-consecutive days. Exercise for 20 to 30 minutes, working on lifting/pushing/pressing activities that target legs, arms, and your spine.Activities such as yoga, Pilates, and tai chi can be very beneficial too as they work on your balance, coordination and flexibility. You’ll notice an improvement in how easily you move around during everyday tasks. Good balance and flexibility will help prevent falls occurring.
- The final measure to keep bones healthy is to cut out smoking and limit your alcohol intake. Smoking slows down the cells that build bone in your body. If you smoke, you have a higher risk of breaking your hip as you get older. But if you give up smoking, your risk of breaking a bone does normalise with time.Drinking excess alcohol – more than 14 units per week – affects your bone’s ability to grow new bone tissue and therefore increases your risk of osteoporosis. In the short term, it can make you unsteady on your feet and more likely to trip, fall and break a bone.
Last updated: June 2026
