Menopause and your bones: osteoporosis risk, bone density scans and what protects you

Hot flashes get all the attention. Bones don't send you any signals at all, which is exactly why we want to talk about them. Osteoporosis is called a silent disease because it usually causes no symptoms until a bone breaks. The years around menopause are when the quiet damage speeds up, and also when you have the most power to slow it down.

Why menopause affects your bones

Bone is living tissue, constantly broken down and rebuilt. Estrogen helps keep that process balanced, and low estrogen after menopause is a recognized risk factor for osteoporosis, according to the NIH. The NIH also notes that for many women, bone loss begins a year or two before menopause. The North American Menopause Society calls estrogen deficiency at menopause the main cause of the bone loss that leads to osteoporosis.

The stakes are real. The Bone Health & Osteoporosis Foundation (BHOF) says studies suggest about one in two women age 50 and older will break a bone because of osteoporosis. The most common sites are the hip, spine and wrist.

What raises your risk

Pulling from the NIH, BHOF and the US Preventive Services Task Force (USPSTF), these are the big ones:

• Being postmenopausal, especially after early menopause or primary ovarian insufficiency
• A parent who broke a hip, or a family history of osteoporosis
• Low body weight or a small frame
• Smoking and heavy alcohol use
• Low calcium or vitamin D intake, or a history of excessive dieting or an eating disorder
• Long-term use of certain medicines, including steroid pills, some antiseizure drugs and proton pump inhibitors
• Conditions such as rheumatoid arthritis, diabetes, celiac disease and chronic kidney disease
• Having already broken a bone

The bone density scan: who should get one

In January 2025, the USPSTF updated its screening recommendation:

• Women 65 and older: screening is recommended.
• Postmenopausal women younger than 65 at increased risk: screening is recommended too. The USPSTF suggests a two-step approach: check for risk factors like those above, and if you have at least one, use a risk tool such as FRAX to decide whether a scan is warranted.

The USPSTF does not set a fixed interval for repeat scans, saying the evidence is limited. Your clinician will base timing on your results and risk.

What the scan is like

The test is called DXA (or DEXA), a low-dose X-ray of your hips and spine. MedlinePlus explains you lie on a padded table, usually in your clothes, while a scanner passes over you. It takes about 10 to 30 minutes and uses very low doses of radiation. You may be asked to stop calcium supplements 24 to 48 hours before, and to skip metal buttons and jewelry.

Reading your T-score

Your T-score compares your bones with those of a healthy young adult. It is one piece of the picture; your overall fracture risk also depends on age, history and other risk factors.

Protecting your bones: what actually helps

Move, and add some load

BHOF recommends two kinds of exercise. Weight-bearing activity, from brisk walking and stair climbing to jogging, dancing or tennis if your joints allow, and muscle-strengthening work like weights, bands, squats and sit-to-stand moves. If you already have osteoporosis or have broken a bone, high-impact exercise may not be right, so check with your clinician first.

Get enough calcium and vitamin D

The NIH Office of Dietary Supplements sets these daily targets, counting food and any supplements together:

Food is the place to start: dairy, canned sardines or salmon with bones, kale, broccoli, bok choy, and fortified foods like some plant milks and cereals for calcium; fatty fish and fortified milk for vitamin D. More is not better. The NIH sets upper limits of 2,000 mg of calcium a day after 50 and 4,000 IU of vitamin D. The NIH also notes that in older adults, calcium and vitamin D supplements slightly increase bone strength, but it is unclear whether they reduce falls or fractures. Ask your clinician whether you need a supplement at all.

Skip the smoke, go easy on alcohol

The NIH lists not smoking (or quitting) and keeping alcohol moderate among its prevention steps.

Medicines and hormone therapy

Lifestyle alone will not reverse osteoporosis once you have it. The North American Menopause Society's 2021 position statement says hormone therapy is the most appropriate way to prevent bone loss at menopause in healthy women, especially those who also have menopause symptoms. Read what changed with HRT in 2025 for the latest on safety labeling.

For diagnosed osteoporosis, the same statement names bisphosphonates and denosumab as the usual treatments, and says women at very high fracture risk should start with a bone-building medicine. Which option fits depends on your risk and history, which is a conversation for your clinician.

When to call your clinician

• You broke a bone from a minor fall, or from something like bending or coughing
• You notice height loss, a stooped posture or new severe back pain, which the NIH notes can signal a spine fracture
• You went through menopause before 45, or have primary ovarian insufficiency
• You have taken steroid pills for three months or longer
• You are 65 or older and have never had a bone density scan

Questions to ask your clinician

1. Based on my risk factors, should I have a bone density scan now, or when?
2. What is my estimated fracture risk, using a tool like FRAX?
3. Do I get enough calcium and vitamin D from food, or do I need more?
4. Would hormone therapy make sense for both my symptoms and my bones?
5. If my scan shows osteopenia or osteoporosis, what are my treatment options?
6. Are any of my current medicines affecting my bones?

Questions

When should I get a bone density scan after menopause?

The USPSTF recommends screening for all women 65 and older, and for postmenopausal women under 65 who are at increased risk based on risk factors and a tool like FRAX. Ask your clinician whether you qualify sooner.

When does bone loss start around menopause?

For many women, bone loss begins a year or two before menopause, according to the NIH, as estrogen starts to fall. The pace varies from woman to woman, which is why risk assessment and screening matter.

How much calcium do I need after menopause?

The NIH recommends 1,200 mg a day for women 51 and older, counting food and supplements together, with an upper limit of 2,000 mg. Food sources are the best place to start.

Does HRT protect your bones?

It can. The North American Menopause Society says hormone therapy is the most appropriate way to prevent bone loss at menopause in healthy women, especially those who also have symptoms. Whether it fits you is a decision for you and your clinician.

What is a normal T-score?

A T-score of -1.0 or higher is normal. Between -1.0 and -2.5 is low bone density (osteopenia), and -2.5 or lower is osteoporosis, according to MedlinePlus.

Keep reading

• Do menopause supplements work? An honest look at black cohosh, soy and the rest
• Perimenopause symptoms: the full list and red flags
• Am I in perimenopause? The stages, explained
• What changed with HRT after the FDA label change
• Hot flash relief without hormones
• How to talk to your doctor about menopause

Education and personal experience, not medical advice. Talk with your own clinician before making health decisions.