Bone health is a topic that often goes unnoticed — because osteoporosis shows no symptoms until the first fracture.

What happens:

After menopause, the decline in estrogen accelerates bone mass loss. Women can lose up to 20% of bone density in the first 5-7 years. SWAN bone substudy data (Greendale et al., J Bone Miner Res, 2017) demonstrated that BMD at the lumbar spine and femoral neck declines most rapidly in late perimenopause and early postmenopause (2-3% per year), closely correlated with estradiol decline.

The WHI CaD trial (18,176 women, 7-year follow-up) found that calcium (1,000 mg) + vitamin D (400 IU) showed a small but significant improvement in hip bone density. Subgroup analysis revealed a possible benefit for older women in hip fracture risk reduction.

What you can do:

  • Strength training 2-3x/week (most important)
  • Weight-bearing exercise (brisk walking, stair climbing, dancing)
  • Calcium 1,200 mg/day + vitamin D 800-1,000 IU/day
  • Adequate protein intake (1.2 g/kg/day) for bone structure
  • Avoid smoking and excessive alcohol
  • DXA scan recommended starting at age 65, or earlier with risk factors
  • HRT can prevent bone loss and reduce fracture risk (approved for prevention)

Medications for established osteoporosis (if diagnosed):

Bisphosphonates (alendronate/Fosamax), raloxifene (SERM), denosumab (Prolia), teriparatide (Forteo) for severe cases — discuss with your doctor.