Bone health after menopause — Reclaim Power Telehealth patient library

Bone Health After Menopause: Screening, What Builds Bone, and When Medication Helps

September 21, 2026

Hormones & Healthy Aging · Bone

Too often the first sign of weak bone is a broken one. You can find out years earlier, and you can do a great deal about it.

Written for my patients. If you are not one, read "call me" as "call your own clinician", and take the questions here to them.

Bone is living tissue. It is being broken down and rebuilt continuously, all your life, and for most of adulthood the two processes roughly balance. After menopause, when estrogen falls, the balance tips. You lose bone faster than you rebuild it, and fastest in the first several years.

About half of women over 50 will break a bone because of osteoporosis. A hip fracture in later life often means losing independence, and that is the outcome I am actually trying to prevent when I bring this up with a woman in her forties who feels strong and has no complaints.

Who should get a bone density scan

The U.S. Preventive Services Task Force reaffirmed the guidance in 2025: every woman 65 and older, and postmenopausal women younger than 65 who have higher risk. The test is a DXA scan, a quick, low-radiation scan of your hip and spine. It takes about fifteen minutes.

Higher risk meansA parent who broke a hip. Low body weight. Smoking. Heavy drinking. Early menopause. Long-term steroid use. Rheumatoid arthritis. Celiac disease. A past bone break from a simple fall.

Reading the resultA T-score between -1 and -2.5 is low bone mass, osteopenia. -2.5 or lower is osteoporosis. I also run a tool called FRAX, which estimates your 10-year fracture risk from the score plus your history. That risk number matters more than the score alone, and it is what decides whether medication is worth discussing.

What builds and protects bone

Strong evidence

Strength and impactBone gets stronger when it is loaded, and it does not respond to walking alone. In the LIFTMOR trial, supervised heavy strength training with impact exercise improved bone density in women who already had low bone mass, and did it safely. This is the single most useful thing on this page, and it is the one most women have been told to avoid. See my strength training page.

Calcium, from food firstWomen over 50 need about 1,200 mg a day. Dairy, canned salmon or sardines with the bones, tofu made with calcium, fortified milks, leafy greens. Supplement only the gap between what you eat and 1,200. More is not better, and very high supplement doses have their own problems.

ProteinBone is partly protein. Aim for about 30 grams per meal. Women who cut calories hard without protein and lifting lose bone along with fat.

Fall preventionMost fractures come from falls, not from bone giving way on its own. Balance training, good lighting, no loose rugs, and a look at any medicine that causes dizziness.

Situational

Vitamin DThe standard daily amount, 600 to 800 IU, is enough for most people. More if you have osteoporosis or absorb it poorly; I will tell you if that is you. Routine testing in healthy adults has not been shown to improve anything.

What hurts bone

Smoking. More than two drinks a day. Long-term steroid pills. Very low body weight. And fast weight loss without strength training, which is why I say this in every GLP-1 conversation: if you are losing weight on a medication, lifting and protein are not optional extras. They are how you keep the weight you lose from including your skeleton.

Medication

If your fracture risk is high, medication cuts it substantially, especially for spine fractures. The options include bisphosphonate pills or a yearly infusion, denosumab injections, and stronger bone-building injections for very high risk. Hormone therapy started around menopause also protects bone, which is one of several reasons it deserves a real conversation rather than a reflex no.

You may have read about jaw problems and unusual thigh fractures with these medicines. They are real, and they are rare. For a woman at high fracture risk, the fractures prevented outnumber those events many times over. I will show you the numbers for your situation rather than asking you to take that on faith.

Call me if

You break a bone from a simple fall or less, lose more than an inch of height, or develop new back pain that feels different from your usual. Any of these can signal a fracture from weak bone, and they change what we do next.

I wrote this for my patients, and it reads the same for everyone: general information, not a plan. If you would like your own numbers read against your own story, that is what a Lab Second Look is for. If you are not sure where to start, the free intro call is fifteen minutes.

A note on how to use this. General information for my patients, not individualized advice.

US Preventive Services Task Force. Screening for osteoporosis to prevent fractures: recommendation statement. JAMA, published January 14, 2025.
Watson SL et al. High-intensity resistance and impact training improves bone mineral density in postmenopausal women with osteopenia and osteoporosis (LIFTMOR). J Bone Miner Res 2018;33(2):211–20.
Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. National Academies Press; 2011.
Black DM, Rosen CJ. Postmenopausal osteoporosis. N Engl J Med 2016;374(3):254–62.

Trang Ca Laube, FNP-BC, FMACP · Reclaim Power Telehealth · Updated September 2026

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Trang Ca Laube, FNP-BC, FMACP

Board-certified Family Nurse Practitioner and Functional Medicine Certified Practitioner. Founder of Reclaim Power Telehealth, seeing adults in Indiana, Colorado, Utah, Washington and Arizona. Author of The Safety Switch. These handouts are general information written for my patients, not individualized advice.

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