When most women think about menopause, they think about hot flushes, night sweats, poor sleep and brain fog. Few think about their bones.

Yet one of the biggest changes happening during menopause is completely silent. You can’t see it, you can’t feel it, and for many women, the first sign there’s a problem is a broken wrist, hip or vertebra after what seemed like a minor fall.

That’s why bone health deserves to be part of every menopause conversation.

What happens to our bones during menopause?

Bone is living tissue. Throughout life, old bone is constantly being broken down and replaced with new bone.

Oestrogen plays an important role in keeping this process balanced.

As oestrogen levels begin to fall during perimenopause and menopause, bone starts to break down faster than the body can rebuild it. The result is a gradual loss of bone mineral density, increasing the risk of osteopenia and, eventually, osteoporosis.

This process often accelerates in the first five to ten years after menopause, making this a particularly important time to think about protecting long-term bone health.

New research adds to the evidence

Research presented at the 2026 Endocrine Society annual meeting has added further evidence that hormone replacement therapy (HRT) may play an important role in protecting bone health during and after menopause.

The study found that women using HRT were significantly less likely to have low bone mineral density than women who were not using HRT. They also had higher bone density in both the hip and spine, even after accounting for factors such as age, smoking, vitamin D levels and years since menopause.

Although this research is awaiting full peer review, it supports what many menopause specialists have understood for years: HRT doesn’t simply relieve symptoms such as hot flushes and poor sleep. For suitable women, it can also help preserve bone density and reduce the long-term risk of osteoporosis.

Bone health isn’t only about HRT

While HRT can be an effective option for many women, it isn’t suitable for everyone and it should never be viewed as the only answer.

Strong bones are built through a combination of factors, many of which are within our control.

Resistance training

One of the most effective ways to maintain bone strength is regular resistance training.

When muscles pull against bone during lifting, carrying or pushing movements, the bones respond by becoming stronger. This is why strength training is recommended throughout adulthood, but becomes especially important during and after menopause.

Contrary to popular belief, walking alone is unlikely to provide enough stimulus to significantly improve bone density, although it remains excellent for overall health.

Weight-bearing activity

Bones respond to impact.

Activities such as brisk walking, hiking, stair climbing, dancing and, where appropriate, gentle jogging or jumping all provide mechanical loading that helps maintain bone health.

The right type of exercise depends on the individual, particularly if osteoporosis is already present.

Protein

Bone isn’t made of calcium alone. 

Around half of bone by volume is made up of protein, which forms the structural framework that minerals attach to.

Many midlife women unintentionally under-eat protein, particularly if they’re dieting or skipping meals. Eating adequate protein throughout the day supports not only muscle maintenance but also healthy bones.

Calcium

Calcium remains essential for bone mineralisation.

Most women can meet their requirements through food, including dairy products, fortified plant milks, tofu, leafy greens and certain nuts and seeds. Supplements may be appropriate for some women but aren’t automatically necessary.

Vitamin D

Vitamin D helps the body absorb calcium effectively.

Living in the UK means many people struggle to maintain adequate vitamin D levels, particularly during autumn and winter. For some women, supplementation may be appropriate, particularly if blood levels are low.

Who may be at higher risk?

Although every woman loses some bone after menopause, certain factors increase the risk of osteoporosis.

These include:

• Early menopause or surgical menopause.
• A family history of osteoporosis.
• Smoking.
• Low body weight.
• Long-term steroid medication.
• Low vitamin D levels.
• Previous low-impact fractures.
• Certain medical conditions affecting nutrient absorption or hormone levels.

If several of these apply, it’s worth discussing your bone health with your GP or menopause specialist.

Should you have a DEXA scan?

A DEXA scan measures bone mineral density and can identify osteopenia or osteoporosis before a fracture occurs.

Not every woman needs one routinely. However, it may be appropriate if you have significant risk factors, have experienced an early menopause, have already had a fragility fracture, or have concerns about your future fracture risk.

Your healthcare professional can help determine whether a scan would be beneficial.

Looking beyond symptom relief

One of the biggest misconceptions about HRT is that it’s simply there to stop hot flushes. 

For many women, symptom relief is only one part of the picture.

Looking after bone health today may help preserve mobility, independence and quality of life decades into the future.

Whether that involves HRT, resistance training, improving nutrition, or a combination of approaches, the important thing is recognising that bone health deserves attention long before problems develop.

The bottom line

Menopause is a natural transition, but it doesn’t mean we have to accept weaker bones as inevitable. Building and protecting bone is something we can influence through the choices we make every day.

Strength training. Eating enough protein. Getting adequate calcium and vitamin D. Staying active. And, for some women, considering HRT as part of an individualised treatment plan.

Because strong bones aren’t just about preventing fractures. They’re about protecting the freedom to keep doing the things you love for years to come.