Menopause and Bone Health: What the Latest Research Says

Menopause is a significant transition in a woman’s life, bringing changes that extend far beyond hot flushes and mood changes. One of the most important—but often overlooked—effects of menopause is its impact on bone health. As oestrogen levels decline, women experience an accelerated loss of bone mineral density, increasing the risk of osteoporosis and fractures.

The good news? Research consistently shows that exercise, nutrition and early intervention can significantly reduce this risk. we can help women navigate menopause with evidence-based assessment, exercise and education to protect bone health and maintain confidence in movement.

Why does menopause affect bone health?

Oestrogen is essential for maintaining healthy bones. It helps regulate the continuous cycle of bone breakdown (resorption) and bone formation. During menopause, declining oestrogen levels cause bone breakdown to outpace bone formation, resulting in accelerated bone loss.

The most rapid decline typically occurs during the menopausal transition and the first 5–10 years afterwards. Women may lose up to 10–20% of their bone mass during this period, making it the fastest phase of bone loss across the lifespan.

According to recent international guidelines, osteoporosis affects approximately one in three women over 50, and osteoporotic fractures are associated with significant reductions in independence, mobility and quality of life.

Osteoporosis: the silent condition

Osteoporosis develops gradually and usually causes no symptoms until a fracture occurs. Common fracture sites include:

• Hip

• Spine (vertebrae)

• Wrist

• Shoulder

These fractures can have long-term consequences, particularly hip and spinal fractures, which are associated with chronic pain, disability and reduced independence.

Risk factors include:

• Early menopause (before age 45)

• Family history of osteoporosis or hip fracture

• Low body weight

• Smoking

• Excess alcohol intake

• Low physical activity

• Inadequate calcium or vitamin D intake

• Long-term corticosteroid use

• Certain medical conditions affecting hormones or nutrient absorption

Exercise: an effective conservative treatment

One of the strongest findings from recent systematic reviews is that exercise is one of the most effective lifestyle interventions for maintaining bone health during and after menopause.

A 2023 review found that progressive resistance training combined with impact-loading exercise consistently improves or maintains bone mineral density at the hip and lumbar spine in postmenopausal women.

What type of exercise works best?

1. Progressive resistance training

Strength training places healthy stress through bone, stimulating new bone formation.

Examples include:

• Squats

• Deadlifts

• Lunges

• Step-ups

• Leg press

• Rows

• Chest press

• Overhead press

2. Impact-loading exercise

Bones respond to impact. Higher-impact activities appear to provide the greatest stimulus for bone adaptation in women without osteoporosis or fracture risk. Depending on your current bone health and fitness level, beneficial activities may include:

• Brisk walking

• Stair climbing

• Hiking

• Skipping

• Jumping

• Jogging

• Racquet sports

3. Balance and functional training

While balance exercises don’t directly increase bone density, they dramatically reduce one of the biggest risks for fractures> falls.

Exercises may include:

• Single-leg balance

• Tai Chi

• Pilates

What if I already have osteoporosis?

Exercise is still strongly recommended. However, programmes should be individualised.

Women with established osteoporosis may need modifications to reduce spinal fracture risk, including avoiding repeated loaded spinal flexion or high-risk twisting movements until assessed by a physiotherapist.

Current guidelines emphasise that people with osteoporosis should remain active rather than avoiding exercise, as inactivity leads to further bone loss, muscle weakness and increased falls risk.

Nutrition matters too>

Exercise builds the stimulus for stronger bones, but nutrition provides the building blocks.

Calcium

Women over 50 generally require around 1,300 mg of calcium daily.

Good food sources include:

• Dairy products

• Calcium-fortified plant milks

• Sardines and salmon

• Tofu (calcium set)

• Leafy green vegetables

• Almonds

Vitamin D

Vitamin D allows calcium to be absorbed effectively.

Many New Zealand women have low vitamin D levels, particularly during winter or if they spend limited time outdoors.

Supplementation may be appropriate for women with confirmed deficiency or increased risk.

Protein

Emerging research highlights adequate protein intake as another essential factor for bone and muscle health.

Higher protein intake, particularly when combined with resistance training, supports both muscle strength and bone maintenance—helping reduce falls and fractures.

Can Physio Help?

Absolutely. Physiotherapy plays an important role in supporting bone health during and after menopause. We begin by assessing your strength, balance, mobility, posture, falls risk, previous injuries and current exercise capacity to gain a clear understanding of your individual needs. From there, we develop a personalised programme that is both safe and effective, helping you build strength and confidence while protecting your bones. Whether you're looking to prevent osteoporosis, manage an existing diagnosis or return to exercise after injury, we can guide you with progressive strength training, osteoporosis-safe exercise prescription, education about bone health, strategies to manage menopause-related joint and tendon pain, and ongoing support to help you move well and stay active for the long term.

What about hormone replacement therapy (HRT)?

For many women, menopausal hormone therapy (MHT/HRT) remains one of the most effective medical treatments for reducing bone loss during early menopause. Current menopause guidelines recognise HRT as an effective option for preventing osteoporosis in women who are under 60 years of age or within 10 years of menopause, provided there are no contraindications.

Other medications—including bisphosphonates, may be appropriate for women with osteoporosis or a high fracture risk. These options should be discussed with your GP or specialist.

Should I have a bone density scan?

You should discuss screening with your GP if you:

• Are over 50 with risk factors

• Have experienced an early menopause

• Have had a previous low-trauma fracture

• Take long-term steroids

• Have a strong family history of osteoporosis

Early identification allows treatment to begin before significant bone loss occurs. Also you can self-refer for these scans locally here

5 things you can do today>

• Lift weights or perform resistance training at least 2–3 times per week.

• Include regular weight-bearing or impact activities where appropriate.

• Meet your calcium and vitamin D requirements.

• Maintain muscle strength, balance and mobility.

• Seek professional advice early if you’re concerned about your bone health.

Bone loss during menopause isn’t inevitable, and neither are fractures. If you’re entering menopause or have concerns about osteoporosis, our physiotherapists can help you develop a personalised, evidence-based plan to support your long-term bone health.

• Beck BR, et al. Exercise Prescription for Osteoporosis: Exercise and Sports Science Australia Position Statement Update. Journal of Science and Medicine in Sport. 2023.

• Kemmler W, et al. Effects of Exercise on Bone Mineral Density in Postmenopausal Women: Umbrella Review. Sports Medicine. 2023.

• Compston J, et al. UK Clinical Guideline for the Prevention and Treatment of Osteoporosis. Archives of Osteoporosis. Updated 2022.

• North American Menopause Society (NAMS). 2022 Hormone Therapy Position Statement.

• Sherrington C, et al. Exercise for Preventing Falls in Older People Living in the Community. Cochrane Systematic Review