How do I keep my bones strong after menopause?

After menopause, oestrogen levels drop sharply. This is the main cause of bone loss in women: the loss is fastest in the first 2-3 years, and in roughly 1 in 3 women it eventually leads to osteoporosis (brittle bones). Understanding why bones weaken helps in making targeted choices.

The foundation for strong bones is a healthy lifestyle. That means getting enough calcium, vitamin D and protein through diet, not smoking, and drinking little alcohol. Smoking, excessive alcohol consumption, long-term use of corticosteroids (such as prednisone) and low levels of physical activity are avoidable risk factors that considerably increase the risk of osteoporosis and bone fractures. This is recommended for all women after menopause.

Regular weight-bearing exercise genuinely helps. In a 5-year study in which older postmenopausal women jumped three times a week while wearing a weighted vest, bone density in the hip remained stable. Women who did not do this lost 3-4% bone density over the same period. Weight-bearing movement, such as walking, dancing or strength exercises, is therefore a proven approach.

For those who need it, there are effective medications. Bisphosphonates are the most commonly used choice: they inhibit bone breakdown and reduce the risk of fractures by approximately 50%. They are available in several forms of administration (daily, weekly, monthly or yearly). Side effect: gastrointestinal complaints with the oral version. Another option is denosumab, an injection that blocks bone breakdown. Important: stopping denosumab without medical supervision is dangerous. In 10% of patients, a rapid rebound occurs within 6-12 months of stopping, with multiple vertebral fractures. You should therefore never stop this medication without consulting a doctor.

Hormone therapy (oestrogen, with or without progestogen) is the only bone-protective therapy that also works in women with a low fracture risk. It reduces the risk of fractures at all sites by 20-40%. At the same time, the risk of side effects such as heart attack and breast cancer differs depending on the type of preparation, dose and age. Weighing the pros and cons is a personal matter here and always requires a conversation with a doctor.

For women with severe osteoporosis, newer bone-building medications exist, such as teriparatide, abaloparatide and romosozumab. These actively stimulate bone formation, rather than only inhibiting breakdown, and are intended for cases with a high fracture risk. Finally, probiotics (such as Lactobacillus reuteri) are sometimes promoted for bone health, but in a carefully designed 2-year study involving 239 women, this agent had no measurable effect on bone loss. The popularity of probiotics for bones is not yet supported by evidence.