Bone health in and after menopause

The window that matters

Oestrogen restrains the cells that break bone down. When it falls, that restraint goes, and the balance between bone formation and bone resorption tips. The steepest loss occurs in a window spanning roughly the year before the final period and the years immediately after it.

The difficulty is that this window is silent. No ache announces it. Women commonly discover their bone density decades later, after a wrist fracture from a low fall, or when a routine measurement shows they have lost height.

What genuinely protects bone

Load. Bone adapts to the forces placed on it. Resistance training and weight-bearing activity, progressively loaded, are the strongest non-pharmacological signals available. Swimming and cycling are excellent for cardiovascular health and do very little for bone, because they do not load it.

Calcium, preferably from food. Dairy, tinned fish with bones, fortified plant milks, leafy greens and tofu set with calcium. Where intake falls short, a supplement fills the gap; where intake is adequate, adding more provides no further benefit.

Vitamin D. Deficiency is common, including in the Caribbean, where sun avoidance and indoor work are more prevalent than the latitude would suggest. It is one of the few tests genuinely worth doing before supplementing, because the right dose depends on where you are starting.

Protein. Bone is not only mineral. Adequate protein intake supports both bone and the muscle that loads it.

Not smoking, and moderating alcohol. Both are independently associated with lower bone density and higher fracture risk.

Medication, briefly and honestly

Hormone therapy prevents bone loss and is approved for that purpose. It is not usually prescribed for bone alone in a woman without symptoms, and that calculation belongs with a clinician who knows your history.

Bone-specific medications exist and are effective for women with osteoporosis or high fracture risk. They are prescribed on the basis of a bone density scan and a fracture risk assessment, not on the basis of age.

When to be scanned

A bone density scan is generally recommended at 65, and earlier where risk factors are present: early menopause, long-term steroid use, a previous low-trauma fracture, a parental hip fracture, low body weight, smoking, or certain medical conditions.

If you reached menopause before 45, that is a specific reason to raise bone with your clinician rather than waiting two decades for a routine scan.

What we do not recommend

A large number of supplements are marketed for bone on the strength of a mineral appearing somewhere in bone biology. Strontium, boron and various proprietary blends fall into this category. The evidence does not support them, and in the case of strontium there are safety considerations. We would rather grade them honestly than sell them.