When we think about menopause symptoms, hot flushes, poor sleep and mood changes often come to mind first. What is happening to our bones is far easier to overlook because bone loss usually causes no symptoms until a fracture occurs.

Oestrogen has an important protective effect on bone. As oestrogen levels fall during perimenopause and menopause, the balance between bone formation and bone breakdown changes. Women can lose bone more rapidly during the first years after menopause, increasing their future risk of osteopenia, osteoporosis and fragility fractures [1][2].

This has come back into focus following updated guidance from the British Menopause Society in August 2026, which reinforces the importance of identifying individual risk, protecting bone health early and choosing treatment according to a woman’s age, menopause history and overall health [1].

At The Menopause Medic, bone health forms part of the bigger midlife health picture. Where appropriate, this can include assessing risk factors, checking relevant blood markers and arranging referral for a DEXA bone density scan.

What Happens to Your Bones During Menopause?

Bone is living tissue that is constantly being broken down and rebuilt.

Before menopause, oestrogen helps regulate this process. When oestrogen levels decline, bone breakdown can begin to outpace bone formation.

This does not mean every woman will develop osteoporosis. However, postmenopausal women are at greater risk, particularly if additional risk factors are present [2].

The difficulty is that you usually cannot feel bone density reducing.

Osteoporosis has sometimes been called a silent condition because there may be no obvious warning signs until someone experiences a fracture.

Osteopenia Versus Osteoporosis

These terms are related but do not mean exactly the same thing.

Osteopenia means bone density is lower than expected but has not reached the threshold used to diagnose osteoporosis.

Osteoporosis means bone strength has reduced sufficiently that the risk of fractures is significantly increased.

A DEXA scan can measure bone mineral density and help clinicians assess where an individual falls within this spectrum [3].

Having osteopenia does not automatically mean you will progress to osteoporosis. Your future risk depends on several factors including age, genetics, lifestyle, medical history and hormone exposure.

Why Early Menopause Matters

Women who experience early menopause before the age of 45, and particularly premature ovarian insufficiency before the age of 40, have fewer years of exposure to protective ovarian oestrogen.

This makes bone health particularly important.

Current British Menopause Society guidance states that oestrogen remains an important treatment for osteoporosis prevention in younger women experiencing menopause, particularly those with premature ovarian insufficiency or early menopause [1].

The NHS also lists early menopause, particularly when HRT has not been used, as a risk factor that may prompt consideration of a DEXA scan [3].

This is one reason early menopause should not be treated simply as an earlier version of the usual menopause transition. Long-term bone and cardiovascular health also need consideration.

What Is a DEXA Scan?

DEXA stands for Dual Energy X-ray Absorptiometry.

A DEXA scan is a quick, painless, low-dose X-ray examination used to measure bone mineral density, usually at the hip and spine [3].

It can help:

• Identify low bone density
• Diagnose osteoporosis
• Estimate future fracture risk
• Establish a baseline before certain treatments
• Monitor bone health where clinically appropriate

A DEXA result is normally considered alongside other risk factors rather than being interpreted in isolation.

Does Every Woman Need a DEXA Scan at Menopause?

No.

Routine DEXA scanning is not required simply because somebody has reached menopause.

It becomes more relevant when additional osteoporosis or fracture risk factors are present [3].

These may include:

• Early menopause
• Premature ovarian insufficiency
• Previous fracture following a minor fall or injury
• Strong family history of osteoporosis or hip fracture
• Low body weight or BMI
• Smoking
• Higher alcohol consumption
• Long-term oral corticosteroid use
• Certain inflammatory conditions
• Conditions affecting nutrient absorption
• Surgical removal of the ovaries at a younger age
• Some breast cancer treatments
• Prolonged periods without menstruation
• Other conditions associated with low bone density

A personalised assessment is more useful than automatically sending every midlife woman for a scan.

What Do DEXA Results Mean?

DEXA results are often expressed as a T-score.

Broadly:

• A T-score of minus 1 or above is considered within the normal range
• Between minus 1 and minus 2.5 is generally classed as osteopenia
• Minus 2.5 or below is generally consistent with osteoporosis

The number itself is only part of the picture.

Age, previous fractures, family history and other clinical risk factors also influence whether treatment is recommended.

What Does the Latest British Menopause Society Guidance Say?

The British Menopause Society updated its consensus statement on osteoporosis prevention and treatment in August 2026 [1].

A key message is that care should be individualised rather than applying one treatment approach to every woman.

The guidance confirms that HRT reduces the risk of vertebral, hip and other osteoporotic fractures while it is being taken.

It also emphasises the particular importance of oestrogen in younger women experiencing early menopause or premature ovarian insufficiency.

For established osteoporosis, other medicines may be considered.

These include:

• Bisphosphonates
• Denosumab
• Parathyroid hormone related treatments
• Romosozumab

The choice depends upon age, fracture risk, previous treatment, medical history and individual circumstances.

These are prescription treatments and require appropriate medical assessment.

Is HRT a Treatment for Osteoporosis?

HRT is primarily prescribed to treat menopause symptoms, but protection against bone loss is an important additional benefit.

NICE confirms that fragility fracture risk is reduced while HRT is being taken [4].

For younger menopausal women, particularly those experiencing menopause earlier than expected, this bone protection can be especially important.

This does not mean every woman should take HRT simply to protect her bones.

The decision should still consider:

• Menopause symptoms
• Age
• Time since menopause
• Personal medical history
• Family history
• Individual benefits and risks
• Personal treatment preferences

Calcium and Vitamin D: Important, but Not the Whole Answer

Calcium and vitamin D are important for normal bone health.

However, the latest BMS guidance makes an important distinction. Adequate calcium intake and vitamin D are part of osteoporosis management, but supplements alone have not been proven to provide adequate fracture protection [1].

The goal should therefore be broader than simply taking a supplement.

Bone health is supported by nutrition, muscle strength, exercise, hormone status and reduction of other modifiable risk factors.

Why Resistance Training Matters

Muscle and bone respond to load.

Resistance training and weight-bearing exercise encourage the body to maintain muscle and bone strength.

Useful activities can include:

• Weight training
• Pilates
• Walking
• Hiking
• Stair climbing
• Bodyweight exercises
• Resistance band exercises

Maintaining muscle is also increasingly important as we age because strength, balance and coordination help reduce falls as well as supporting the bones themselves.

Protein Matters Too

Bone health is not only about calcium.

Protein supports muscle tissue and contributes to the structural framework of bone.

Maintaining adequate protein intake becomes increasingly important through midlife, particularly for women combining dietary changes with resistance training or medical weight loss treatment.

Extreme dieting or rapid weight loss without adequate protein and strength training may result in unwanted loss of lean muscle.

What Can Blood Tests Tell Us About Bone Health?

Blood tests cannot diagnose osteoporosis. That requires appropriate clinical assessment and, where indicated, bone density imaging.

However, blood testing may help identify factors relevant to bone health.

Depending on the individual, this might include:

• Vitamin D
• Calcium
• Thyroid function
• Kidney health
• Liver health
• Full blood count
• Vitamin B12 and folate
• Hormone markers where clinically relevant

The Menopause Medic’s Women’s Health and Hormone Panel and broader health panels can help provide useful information about nutritional, hormonal and metabolic health alongside clinical assessment.

Bone Health and Medical Weight Loss

Bone and muscle health also deserve consideration when undertaking significant weight loss.

GLP-1 medicines can produce substantial weight reduction in appropriate patients. However, any effective weight loss programme should aim to protect muscle mass and support nutrition at the same time.

For women in perimenopause and menopause, this means considering:

• Adequate protein
• Resistance exercise
• Vitamin D status
• Overall nutritional intake
• Bone risk factors
• Menopause hormone status

Weight is only one measure of health. Preserving strength, muscle and bone should form part of the plan.

When Should You Ask About a DEXA Scan?

Consider discussing bone health with your clinician if you:

• Experienced menopause before 45
• Have premature ovarian insufficiency
• Have had a fracture following a relatively minor injury
• Have a strong family history of osteoporosis
• Have been taking corticosteroids for a prolonged period
• Have a low BMI
• Have undergone treatment that may reduce bone density
• Smoke or drink heavily
• Have a medical condition associated with reduced bone density
• Are concerned about your personal osteoporosis risk

It may be that a scan is unnecessary. The important thing is to assess your actual risk rather than wait until a fracture occurs.

Personalised Bone Health Support at The Menopause Medic

The Menopause Medic takes a whole-health approach to menopause.

Alongside personalised HRT and menopause consultations, the clinic can arrange or facilitate diagnostic investigations where clinically appropriate, including DEXA scans, mammography and ultrasound referrals.

Blood testing is also available to assess relevant nutritional, hormonal, cardiovascular and metabolic markers.

Consultations are available in Berkhamsted and St Albans, with virtual appointments available across Hertfordshire and the UK.

Women travelling from Hemel Hempstead, Tring, Watford, Harpenden, Welwyn Garden City, Kings Langley, Rickmansworth, Amersham, Chesham and surrounding areas can access specialist menopause assessment locally.

References

[1] British Menopause Society. Prevention and treatment of osteoporosis in postmenopausal women. Updated August 2026.

[2] NHS. Osteoporosis.

[3] NHS. Bone density scan, DEXA scan.

[4] NICE. Menopause: identification and management, NG23.

[5] The Menopause Medic. Diagnostics and testing services.

Medical Disclaimer

This article is for general information and educational purposes only. It does not constitute individual medical advice, diagnosis or treatment. Bone density testing, HRT and osteoporosis treatments should be considered according to individual medical history and clinical risk. Please speak to an appropriately qualified healthcare professional if you have concerns about your bone health.