At Nervana Medical in Sandy, Utah, we understand that menopause is more than a stage of life; it is a transformation that impacts your overall health and well-being. One of the most important yet often overlooked effects of menopause is its impact on bone health. As estrogen levels fall, bone resorption increases, leading to decreased bone mineral density and a higher risk of fractures. Through our hormone optimization and medical concierge programs, we offer patients personalized strategies to protect bone health, preserve vitality, and live with strength and independence.

How Menopause Affects Bone Health

Estrogen plays a central role in regulating bone remodeling. When estrogen levels drop during menopause, bone resorption accelerates, resulting in rapid bone loss and deterioration of bone structure (Walker & Shane, 2023). The risk of fragility fractures rises sharply during this time,affecting up to 50% of postmenopausal women and these fractures are linked with loss of independence and higher mortality rates (Walker & Shane, 2023).The rationale for these recommendations is the clear evidence that estrogen deficiency after menopause drives osteoclast activation and bone loss, making postmenopausal women particularly vulnerable to osteoporosis and its complications.

The Timing of Bone Loss

Bone loss does not begin only after menopause, it often starts earlier. Research shows that increased bone turnover begins about two years before the final menstrual period and peaks in the first 1–1.5 years after. This phase is strongly influenced by hormonal changes, including declining estradiol and rising follicle-stimulating hormone (FSH), as well as individual factors such as body mass index and ethnicity (Sowers et al., 2013; Park et al., 2021).

Women who experience earlier menopause are at even greater risk of osteoporosis and fractures, independent of age. In fact, the number of years since the final menstrual period is more predictive of bone density than age itself (Shieh et al., 2022). 

Beyond Hormones: Inflammation and Muscle Loss

Menopause affects more than estrogen levels. Estrogen deficiency also promotes a pro-inflammatory state, with higher levels of cytokines that stimulate bone resorption (Fischer & Haffner-Luntzer, 2022). At the same time, both muscle and bone mass decline during menopause, increasing the risk of sarcopenia (muscle loss) alongside osteoporosis. Fortunately, physical activity and strength training can help offset these losses, supporting both muscle and bone health (Sipilä et al., 2020; Agostini et al., 2018).

Prevention and Treatment Options

Protecting bone health in menopause requires a combination of lifestyle and medical strategies. Preventive measures include:

• Adequate calcium and vitamin D intake
• Regular weight-bearing and strength-building exercise
• Smoking cessation and moderation of alcohol use

For women at high risk of fracture, pharmacologic treatment may be necessary (de Villiers, 2024; Lupsa & Insogna, 2015).

Hormone Replacement Therapy (HRT)

Hormone therapy is a powerful option for women in the early years of menopause. HRT reduces bone resorption, preserves bone density, and lowers fracture risk by 20–40% according to large studies, including the Women’s Health Initiative (Gosset et al., 2021; Shah & Ariel, 2023). Both oral and transdermal estrogen are effective, and lower or bioidentical doses are often preferred for safety (Shah & Ariel, 2023; Levin et al., 2018).

It is important to note that once HRT is discontinued, bone density begins to decline again, underscoring the need for long-term planning (Eastell et al., 2019). Current guidelines recommend HRT for women with menopausal symptoms or premature menopause who do not have contraindications.

Why Concierge and Hormone Care Make a Difference

Every woman’s menopause journey is unique. At Nervana Medical, our medical concierge and hormone optimization programs provide a personalized approach to bone health and overall wellness. From hormone testing and individualized HRT plans to nutritional guidance and lifestyle support, our goal is to help you maintain strong bones, prevent fractures, and continue living an active, independent life.

Conclusion

Menopause is a pivotal stage where bone health, hormones, and overall wellness intersect. Estrogen deficiency, inflammation, and muscle loss all contribute to increased fracture risk, but proactive care can make a significant difference. At Nervana Medical in Sandy, Utah and through our telehealth programs across Arizona, Idaho, Nevada, Montana, Wyoming,Colorado and California; we are here to guide you with personalized hormone and concierge care that supports your health today and protects your future.

Interested in obtaining a DEXA scan? Schedule your Hormone Consultation today!

References

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Crandall, C. J., Mehta, J. M., & Manson, J. E. (2023). Management of menopausal symptoms: A review. JAMA, 329(5), 405–420. https://doi.org/10.1001/jama.2022.24140

de Villiers, T. J. (2024). Bone health and menopause: Osteoporosis prevention and treatment. Best Practice & Research Clinical Endocrinology & Metabolism, 38(1), 101782. https://doi.org/10.1016/j.beem.2023.101782

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