What is osteoporosis?

Osteoporosis, sometimes called brittle bones, is when bones become weaker and break more easily. It develops slowly over years. It is most common in older people and in women after menopause, but anyone can develop it (NHS, Osteoporosis).

Osteoporosis often causes no symptoms. It may go unnoticed until a bone breaks. The first sign is often a bone that breaks in a minor fall or after a small knock (NHS, Osteoporosis).

Why does menopause affect bones?

Bone is living tissue that is constantly renewed. Old bone is broken down and new bone is built in its place. Before menopause this balance is usually maintained, and bone mass stays fairly stable (NAMS, 2021).

Estrogen (the main female sex hormone) plays an important part in keeping this balance. As estrogen falls in perimenopause, bone breakdown speeds up and outpaces bone building. According to the 2021 position statement of The Menopause Society (formerly NAMS), this period of rapid loss begins 1–3 years before menopause and lasts 5–10 years. During this time the average loss is about 2 percent a year. Across the transition, bone density in the spine and hip falls by an average of 10–12 percent. After that, loss slows to about 0.5 percent a year (NAMS, 2021).

In other words, bone loss does not wait for your final period; it starts during the perimenopause years.

How significant is fracture risk in menopause?

Fractures linked to osteoporosis are discussed most often in the hip, the spine and the forearm (wrist). According to US data in The Menopause Society statement, a 50-year-old white woman’s risk of having an osteoporosis-related fracture over the rest of her life has been calculated at about 40 percent (NAMS, 2021). This figure comes from one group in the US. The same figure may not apply in Türkiye or elsewhere. Still, it shows why bone health gets attention at this stage of life.

Who is at higher risk of osteoporosis?

The NHS lists the factors that raise osteoporosis risk as follows (NHS, Osteoporosis):

  • Older age and menopause
  • A parent with osteoporosis
  • White ethnic background
  • Not enough calcium or vitamin D
  • Low body weight
  • Smoking
  • Drinking too much alcohol
  • Not being very active
  • Conditions such as diabetes or rheumatoid arthritis
  • Taking steroid (cortisone) tablets

The Menopause Society statement also lists low body weight, a parent with a hip fracture and smoking among additional risk factors (NAMS, 2021). Early menopause means your bones go without estrogen for longer; early menopause covers this in detail.

Bone density is assessed with a scan called DEXA (or DXA), which uses low-dose X-rays. The NHS describes it as quick and painless; the radiation used is much lower than a standard X-ray. It is not done during pregnancy (NHS, DEXA scan). Together with your age and sex, the result helps your clinician make decisions (NHS, Osteoporosis).

There are small differences between guidelines, but the main line is similar:

  • US Preventive Services Task Force (USPSTF, 2025): Screening is recommended for all women 65 and over. For women under 65 who are postmenopausal and have at least one risk factor, it recommends first assessing risk with a risk calculation tool, then scanning if the risk comes out high (USPSTF, 2025).
  • The Menopause Society (2021): Recommends a scan after menopause for women who have had a fracture since menopause, have a condition or take a medicine that causes bone loss, are 65 or over, or are 50 or over with an additional risk factor such as low body weight, a parent with a hip fracture, or smoking (NAMS, 2021).
  • NHS: Does not give a specific screening age. It says that if you think you are at risk, your GP (family doctor) will assess your risk and refer you for a scan if needed (NHS, Osteoporosis).

In short, if you are under 65, whether you need a scan depends on your risk factors. The NHS also says the scan is recommended for people over 50 at risk of osteoporosis and for people under 50 with risk factors such as smoking or a previous fracture (NHS, DEXA scan). You make this decision together with your clinician.

Does osteoporosis cause symptoms?

Osteoporosis itself is silent, but small fractures in the spine can lead to these symptoms (NHS, Osteoporosis):

  • Back pain, sometimes sudden and severe
  • Loss of height
  • Stooping or a forward curve in the back

If you notice any of these, tell your clinician. Back and joint pain are also common in menopause for other reasons; to tell them apart, see joint and muscle pain.

Calcium and vitamin D: general information

This page does not recommend supplements. The following is only general information from the sources:

  • Calcium. According to the NHS, adults need 700 mg of calcium a day. Good sources include dairy foods such as milk and cheese, green leafy vegetables such as curly kale, plant-based drinks with added calcium, and fish eaten with their bones, such as sardines (NHS, Calcium). The Menopause Society statement reports that the US recommendation for postmenopausal women is 1,000–1,200 mg a day (NAMS, 2021). Because the sources give different figures, it is best to talk to your clinician about the right amount for you.
  • Vitamin D. The body makes most of its vitamin D in the skin from sunlight. The NHS says adults need 10 micrograms of vitamin D a day, and that oily fish, egg yolks and foods with added vitamin D are among the sources. Too much vitamin D can also be harmful (NHS, Vitamin D).
  • Movement. For bone health, the NHS recommends regular weight-bearing, strengthening and balance-improving exercise; it also lists not smoking and limiting alcohol among its prevention tips (NHS, Osteoporosis).
  • Preventing falls. Reducing the risk of falls at home is also part of reducing fracture risk (NHS, Osteoporosis).

What can you track yourself?

  • Note the date of your last period and your age at menopause.
  • Write down any past fractures and how they happened.
  • Find out whether either of your parents has had a hip fracture.
  • Prepare a list of the medicines you take, especially steroids.
  • Measure and record your height once a year.

When should you see a doctor about bone health, and what should you ask?

If one or more of the risk factors above apply to you, if you have reached menopause and have never talked about your bone health, bring it up at your next appointment. If you have had a hip or spine fracture, or have noticed you are getting shorter, go without waiting.

Questions you could ask:

  • Is a fracture risk assessment appropriate for me?
  • Do I need a bone density scan, and if so, when?
  • Do the medicines I take affect my bones?
  • Am I getting enough calcium and vitamin D from my diet?
  • Which exercises are safe for me?

This page does not describe treatment options. Talk to your clinician about the options for protecting your bone health.