It's normal for women to gradually lose bone density from the age of about 35. But after the menopause bone loss speeds up.
Women can lose up to 20% of their bone density in the five to seven years after the menopause. This makes post-menopausal women more at risk of osteoporosis (weak bones) and fractures.
Why does bone loss speed up after the menopause?
The rapid dip in bone density after the menopause is caused by falling levels of the female hormone oestrogen. Oestrogen helps to protect bone strength.
"While we still have oestrogen on board it's very useful for keeping our bones healthy," says Dr Heather Currie, managing director of Menopause Matters. "By the time we have the menopause, we are producing fewer hormones and it has a detrimental effect on our bones.
"When someone loses oestrogen at a younger age than normal and has an early or premature menopause, it has a worsening effect later on," says Dr Currie. "The longer we have oestrogen, the better it is for our bones."
Keeping bones strong after the menopause
Osteoporosis is more common after the menopause, but women often aren't aware that they have it. "Osteoporosis doesn't cause any symptoms. A fracture is often the first sign, and osteoporotic fractures are increasing," says Dr Currie.
While you can't halt bone loss entirely after the menopause, there is plenty you can do to slow it down. "I encourage women to see the menopause as a wake-up call," says Dr Currie. "It's a great time to review your diet and lifestyle."
Here are some simple steps you can take before or after the menopause to protect your bone health.
Even if you haven't been physically active before, adopting an active lifestyle after the menopause will help to protect your bones.
It's recommended that adults aged 19 to 64 do at least 150 minutes of moderate-intensity activity in bouts of 10 minutes or more each week. This could include activities such as cycling or brisk walking. You should also try to avoid sitting for long periods, for example, watching TV, playing video games or sitting at a computer.
Weight-bearing exercises and resistance exercises are particularly important for improving bone strength and helping to prevent osteoporosis. This is because they place stress on the muscles and bones, which helps to strengthen them.
Weight-bearing exercises are ones where your legs and feet support your weight. High impact weight-bearing exercises, such as running, skipping, dancing and aerobics are all great for strengthening muscles, bones and joints, and can be part of your 150 minutes of moderate intensity activity.
With resistance exercises you use your muscle strength to work against resistance. Government guidelines recommend this type of activity twice a week. Examples include press-ups, exercising with weights or using weight equipment at a gym. The action of muscles pulling on the bones boosts your bone strength.
See more on exercises for strong bones.
Eat a balanced diet
A healthy, balanced diet that includes calcium and vitamin D will help maintain healthy bones after the menopause. Good sources of calcium include green, leafy vegetables (but not spinach), nuts, seeds, dried fruit, tinned fish with the bones in, and dairy products like milk, yoghurt and cheese. Lower-fat dairy products contains just as much calcium as full-fat ones.
Good food sources of vitamin D include oily fish, eggs, and fat spreads or breakfast cereals fortified with vitamin D, although it can be difficult to get enough vitamin D from food alone.
Therefore all adults are advised to consider taking a daily vitamin D supplement, particularly in the winter months (October to March).
See more on eating for bone health.
Sunlight and vitamin D
Sunlight on your skin between from late March/April to the end of September triggers the production of vitamin D so you might choose not to take a vitamin D supplement during these months. Take care not to let skin redden or burn.
Read more on vitamin D and sunlight.
Drink sensibly and don't smoke
Smoking is linked to a higher risk of osteoporosis and so is drinking too much alcohol. Quitting smoking will also help to lower your risk of heart disease, cancer and other smoking-related diseases.
Men and women are advised not to regularly drink more than 14 units a week.
See how to keep track of your alcohol units.
Hormone replacement therapy (HRT) and bone health
HRT can be an effective treatment for common menopausal symptoms like hot flushes, night sweats, sleep disturbance and achy joints. It works by replacing oestrogen, which naturally begins to drop before the menopause. HRT can also help to maintain bone density and reduce the risk of osteoporosis.
HRT isn't suitable for all women and some women prefer not to take it, but it is recommended for certain groups.
"All women who experience an early or premature menopause should be offered HRT, as there is an increased risk of osteoporosis, as well as heart disease and dementia," says Dr Currie.
The average age for women to have their menopause is 52. If your periods stop before the age of 45 it's considered an early menopause. If they stop before the age of 40 it's considered a premature menopause.
"Women who have a strong family history of osteoporosis should also consider taking HRT for bone health as well as the control of menopause symptoms," says Dr Currie.
For more information about the risks and benefits of HRT see your GP.
Read more about HRT and the menopause.