How do I keep my bones strong after menopause?

After menopause, your oestrogen levels drop sharply, and that is the main driver of bone loss in women. The loss is fastest in the first two to three years. In approximately one in three women, this eventually leads to osteoporosis.

The foundation is a healthy lifestyle: adequate calcium, vitamin D and protein, not smoking, and drinking little alcohol. Smoking, excessive drinking, long-term use of corticosteroids such as prednisone, and low levels of physical activity all considerably increase your risk of bone fractures. These are all modifiable factors.

Weight-bearing exercise demonstrably works. In a five-year study, older women jumped three times a week while wearing a weighted vest. Their hip bone density remained stable, whereas women who did not do this lost 3-4%. Walking, dancing or strength training are therefore a proven approach.

If you need medication, bisphosphonates are the most commonly used choice. They inhibit bone breakdown and reduce the risk of fractures by approximately 50%. They are available in daily, weekly, monthly or yearly forms. The pill form can cause gastrointestinal complaints. Another option is denosumab, an injection that blocks bone breakdown. Never stop taking it without consulting your doctor: in 10% of users, multiple vertebral fractures occur within six to twelve months of stopping.

Hormone therapy (oestrogen, sometimes combined with progestogen) is the only bone-protective therapy that also helps at a low fracture risk. It reduces the risk of fractures at all sites by 20-40%. The risk of side effects such as heart attack or breast cancer differs by type, dose and age, so the trade-off is always personal. For severe osteoporosis, newer bone-building agents exist, such as teriparatide and romosozumab, which actively stimulate bone formation rather than merely inhibiting breakdown. Probiotics are promoted for bone health, but in a carefully designed two-year study of 239 women, they had no measurable effect on bone loss.