Osteoporosis

Published: April 24, 2026

Osteoporosis literally means “porous bones” that become more brittle and breaks easily. Bone is continually being broken down and replaced. When you have osteoporosis, more bone is broken than being built and this causes more bone loss to occur. Your bones can break more easily.
Before menopause estrogen protects our bones. However, when menopause occurs, and our levels of estrogen decline, we lose bone and as a result bone density decreases.

Estrogen deficiency occurring at menopause is the most likely factor that women develop osteopenia (low bone mass) and osteoporosis. It may rapidly occur in the first five years after menopause, when bone loss can reach 3 to 4 percent of total bone mass.

Osteoporosis is called “the silent disease” because it has no symptoms until bone loss is significant and fractures occur, most commonly in the wrist, spine and hip.

What is Osteopenia?

Osteopenia refers to reduced bone mineral density (BMD) that is lower than normal but not as severe as osteoporosis. It is typically identified through a bone density scan (DEXA) and represents an intermediate stage between healthy bone and osteoporosis. Osteopenia itself does not cause symptoms and many people only discover it after a minor fracture or during routine screening.

Who’s at Risk?

Menopause accelerates bone loss; other factors include:

Caucasian/Asian ethnicity, family history
Early/surgical menopause, thin frame (BMI <20)
Smoking, excess alcohol (>2 drinks/day), inactivity
Low calcium/vitamin D, high caffeine/soda intake
Conditions: hyperthyroidism, diabetes, celiac, steroids >3 months
FRAX tool predicts 10-year fracture risk—use it with your clinician.

Diagnosis

Osteoporosis is diagnosed with a bone density test called a DXA (or DEXA) scan, which is the gold standard. This test measures bone strength and provides a T-score:

A T-score of -2.5 or lower indicates osteoporosis
A T-score between -1.0 and -2.5 indicates low bone mass (osteopenia)

Screening is recommended starting at age 65 for women, or earlier (around age 50) if there are risk factors such as menopause, family history, certain medications, or fractures.

If a standard DXA scan is not available, alternative options such as forearm DXA or ultrasound may be used, though they are less precise.

Prevention & Treatment

Lifestyle First:

Weight-bearing exercise (walking, weights, dancing) 30+ min/day.
Calcium 1,200 mg/day (dairy, kale, almonds, fortified foods).
Vitamin D 800–2,000 IU/day (sun, salmon, supplements).
Fall-proof home: rugs secured, good lighting, hip protectors.
Quit smoking; limit alcohol.

Medications (for moderate-high risk):

Bisphosphonates (alendronate, risedronate, zoledronate): First-line; build bone 5–10% first year.
Denosumab (Prolia): Injection every 6 months; for high-risk.
Anabolics (romosozumab, teriparatide): Stimulate new bone (osteoporosis with fractures).
Hormone therapy: Estrogen ± progesterone; preserves bone if started <60, no breast cancer history.
Raloxifene: SERM for spine protection + breast benefits.
Calcitonin: Nasal spray for pain relief post-fracture.

Get an assessment of your bone health and risk factors at the time of perimenopause. Discuss prevention and treatment with your healthcare provider.