Bone health becomes increasingly important as women approach and enter menopause. Declining estrogen levels accelerate bone loss, increasing the risk of osteopenia, osteoporosis, and fractures. Fortunately, there are steps you can take to protect your bones, including adequate calcium and vitamin D intake, regular weight-bearing and strength-training exercise, and appropriate bone density screening.
Bone density refers to the amount of mineral, primarily calcium, contained within your bones. Higher bone density generally means stronger bones that are less likely to fracture.
As we age, our bodies gradually lose bone mass. This process accelerates during the menopause transition as estrogen levels decline.
Normal bone density: Your bones have a healthy amount of mineral content.
Osteopenia: Bone density is lower than normal, but not low enough to be classified as osteoporosis. This does not necessarily mean you need medication, but it is an opportunity to focus on protecting your bones.
Osteoporosis: Bone density is significantly reduced, increasing the risk of fractures, particularly in the spine, hips, and wrists.
A DEXA scan (also called a DXA scan) is a quick, painless imaging test that measures bone density, usually at the hip and lower spine. It uses a very small amount of radiation.
Your results are typically reported as a T-score, which compares your bone density to that of a healthy young adult.
-1.0 or higher: Normal bone density
Between -1.0 and -2.5: Osteopenia
-2.5 or lower: Osteoporosis
These classifications generally apply to postmenopausal women and adults age 50 and older.
Not necessarily! Many women with osteopenia never develop osteoporosis.
Your risk of fractures depends on more than your bone density alone. Age, family history, prior fractures, medications, and other health conditions also play important roles.
Your healthcare provider may use a fracture risk assessment tool called FRAX to help determine whether lifestyle changes, additional monitoring, or medication would be beneficial.
Although some bone loss is a natural part of aging, there are several steps you can take to maintain strong bones and reduce your risk of fractures.
Regular exercise helps maintain bone strength, muscle mass, and balance.
Weight-bearing exercise: Walking, hiking, dancing, and stair climbing help support bone health.
Strength training: Resistance exercises using weights, resistance bands, or body weight help preserve muscle and bone strength.
Balance and flexibility: Yoga, tai chi, and balance exercises can help reduce the risk of falls and fractures.
Aim for at least 150 minutes of moderate physical activity per week, along with strength training at least twice weekly.
Avoid smoking: Tobacco use contributes to bone loss and increases fracture risk.
Limit alcohol: Excessive alcohol consumption can weaken bones and increase the risk of falls.
Maintain adequate nutrition: A balanced diet with sufficient protein, calcium, and vitamin D supports bone and muscle health.
Prevent falls: Wear supportive footwear, maintain good vision, and address balance or mobility concerns.
Certain factors can increase your risk of osteoporosis, including early menopause, a family history of hip fractures, low body weight, prior fractures, and prolonged use of certain medications, particularly oral corticosteroids. Talk with your healthcare provider about whether earlier bone density screening may be appropriate.
Calcium and vitamin D work together to maintain strong bones. Calcium provides the building blocks for bone, while vitamin D helps your body absorb calcium.
Getting enough of both is especially important during and after menopause.
Recommended daily intake varies by age:
Women ages 19–50: 1,000 mg calcium + 600 IU vitamin D
Women ages 51–70: 1,200 mg calcium + 600 IU vitamin D
Women ages 71 and older: 1,200 mg calcium + 800 IU vitamin D
These recommendations represent total daily intake from food and supplements combined.
Food is the preferred source of calcium whenever possible. Many women can meet their daily calcium needs through a combination of dairy products, fortified foods, and other calcium-rich foods.
Common sources include:
Milk or fortified plant-based milk
Yogurt and cheese
Calcium-fortified orange juice and cereals
Calcium-set tofu
Leafy greens such as kale and bok choy
Canned salmon or sardines with bones
If you are unable to meet your calcium needs through food alone, a supplement may be helpful.
Tips for Calcium Supplements
Supplement only the amount needed to make up the difference between your dietary intake and your daily goal.
Calcium is best absorbed in doses of 500–600 mg or less at a time.
Calcium carbonate is generally best taken with food.
Calcium citrate can be taken with or without food and may be preferable for women taking acid-reducing medications.
Taking more calcium than recommended does not provide additional bone protection and may increase the risk of side effects, including constipation and kidney stones.
Vitamin D helps your body absorb calcium and maintain healthy bones.
Sources include:
Fatty fish such as salmon and trout
Fortified milk and plant-based milks
Fortified cereals
Egg yolks
Sunlight exposure
Because relatively few foods naturally contain vitamin D, some women may benefit from supplementation.
Do I Need a Vitamin D Supplement?
Many adults can meet their vitamin D needs through a combination of diet and supplements when necessary.
Vitamin D3 (cholecalciferol) is a commonly used supplement.
Higher doses may be recommended for individuals with documented vitamin D deficiency or certain medical conditions.
Routine high-dose vitamin D supplementation is not recommended for everyone.
Do I Need My Vitamin D Level Checked?
Routine vitamin D blood testing is not necessary for most healthy adults. Testing may be appropriate for women with osteoporosis, certain medical conditions affecting nutrient absorption, or other risk factors for vitamin D deficiency.
The Bottom Line: Focus on getting enough calcium through your diet first, supplement only when needed, and avoid taking excessive doses of calcium or vitamin D. Your healthcare provider can help determine whether supplementation or additional testing is appropriate for you.
A DEXA scan (also called a DXA scan) is a simple, painless test that measures bone density and helps identify women at increased risk for osteoporosis and fractures.
Women age 65 and older: Routine bone density screening is recommended, even without symptoms or other risk factors.
Postmenopausal women younger than 65: Earlier screening may be recommended if you have risk factors for osteoporosis or fractures.
Women with certain medical conditions or medications: Bone density testing may be appropriate at a younger age depending on your medical history.
Factors that may increase your risk include:
Early menopause, particularly before age 45
Low body weight
A parent with a history of hip fracture
A personal history of fractures after a minor fall or injury
Smoking or excessive alcohol consumption
Long-term use of oral corticosteroids, such as prednisone
Certain medical conditions that affect bone health or nutrient absorption
A DEXA scan is quick, painless, and noninvasive.
You will lie on a padded table while a scanner measures bone density, usually at your hip and lower spine.
The test typically takes about 10–20 minutes.
It uses a very small amount of radiation.
No injections or medications are required.
The timing of repeat testing depends on your initial results, age, fracture risk, and whether you are receiving treatment. Some women may need repeat testing in approximately 1–2 years, while others with normal bone density and low fracture risk may not need another scan for several years.
Your healthcare provider will recommend an appropriate screening interval based on your individual circumstances.
Not necessarily! If you have experienced early menopause, have a history of fractures, or have other risk factors for osteoporosis, talk with your healthcare provider about whether earlier screening would be beneficial.
Your DEXA scan helps assess your bone health and risk of future fractures. Your results are interpreted alongside your age, medical history, and other risk factors.
Not necessarily! Many women with osteopenia do not require medication. Lifestyle changes, adequate calcium and vitamin D intake, and periodic bone density monitoring may be sufficient.
FRAX (Fracture Risk Assessment Tool) estimates your risk of experiencing a hip fracture or other major osteoporotic fracture over the next 10 years. It considers factors such as your age, bone density, family history, previous fractures, smoking, and certain medical conditions. Your healthcare provider may use this information to help determine whether additional evaluation or treatment is recommended.
If your DEXA scan shows osteoporosis or an increased risk of fractures, additional evaluation or medication may be recommended to help protect your bones. Your primary care provider or an osteoporosis specialist can help determine whether treatment is appropriate based on your individual results and medical history. Regardless of your results, maintaining adequate nutrition, staying physically active, and taking steps to prevent falls remain important for long-term bone health.