While menopause brings expected symptoms like hot flashes, night sweats, and weight gain, there’s another change that often slips under the radar: bone loss, a silent process that can increase your risk of fractures as you age.
But why do bones become more fragile and prone to breaks during this stage of life?
In this article, we’ll dive into the effects of menopause on bone density and the factors behind accelerated bone loss, helping you understand why this process occurs and what you can do about it.
Bone Loss for Each Stage of Menopause
Women often experience bone loss during menopause, with its effects varying at different stages. So, what changes occur in your bones as you progress through each phase?
Perimenopause
Perimenopause is the transition phase leading up to menopause, often beginning in a woman's 40s, although it can start earlier for some women, even in their mid-30s. (1)
This phase encompasses the menopausal transition (MT) and may last anywhere from a few months to up to 10 years. (2)
During perimenopause, as hormones lower, menstrual cycles become irregular, and women may experience symptoms such as hot flashes, night sweats, mood swings, and sleep disturbances.
One of the most important changes during this stage is silently happening within your bones.
Estrogen, which supports healthy bone density, begins to fluctuate and may remain adequate for a time but eventually declines. This fluctuation leads to an imbalance in the natural process of bone turnover, where bone breakdown occurs faster than bone rebuilding. (3)
Consequently, bone mineral density (BMD) begins to decline. (4)
BMD measures the amount of mineral matter, primarily calcium, in bones, which is important for maintaining strength and structure. When BMD decreases, bones become weaker and more susceptible to fractures.
In early perimenopause, bone loss tends to be minimal, and BMD remains stable. However, as women progress into late perimenopause when hormones are at a minimum, bone loss accelerates, particularly in areas such as the lumbar spine (lower back) and femoral neck (part of the hip). (5)
In fact, research findings from the Study of Women’s Health Across the Nation (SWAN) show that the steepest bone loss happens during late perimenopause and early postmenopause, precisely when estrogen levels take a sharp drop. (6)
Researchers followed a diverse group of 2,176 women, tracking changes in bone mineral density (BMD) in the lumbar spine and hip across six years as they transitioned through menopause.
The research found that BMD stayed stable during the early stages of perimenopause and premenopause (our cycling years, prior to perimenopause).
However, as women entered late perimenopause, closer to menopause, bone density started to decline more rapidly—about 1.8-2.3% per year in the lumbar spine and 1.0-1.4% in the hip.
This accelerated loss continued through the early postmenopausal years.
These findings show that while bone density changes are minimal in early perimenopause, bone loss can speed up as estrogen levels fall in late perimenopause and loss can remain high in the early postmenopausal years.
Menopause
The World Health Organization (WHO) defines menopause as the point at which a woman has gone 12 consecutive months without a menstrual period, marking the permanent end of menstrual cycles. (7)
In the United States, the average age for women to experience menopause is 51. This transition generally occurs between the ages of 45 and 55, although it can happen earlier for some women due to factors such as genetics, smoking, or certain medical conditions. (8)
During menopause, ovaries stop releasing eggs and greatly reduce the production of reproductive hormones like estrogen and progesterone, resulting in hormonal changes. (9)
This disruption in hormonal levels leads to an imbalance in bone remodeling processes, where the rate of resorption surpasses the rate of new bone formation. (10)
Thus, women may experience up to 20% loss in bone density during the first five to seven years following menopause, with a pronounced effect on trabecular bone, the spongy tissue located in the spine and hips. (11)
Their bones become brittle and more susceptible to fractures, particularly in the spine, hips, and wrists, and may lead to stooped posture and loss of height due to vertebral fractures, impacting breathing and mobility. (12)
This is supported by a study published in the Journal of Climacteric, which found that women in their 40s who are in the menopausal stage experience a 3.3% annual increase in bone loss, which can double in later years. (13)
Researchers followed women aged 40 and older who were referred to a menopause outpatient clinic for bone mineral density (BMD) measurements.
The results revealed that 52.5% of the participants had normal BMD, while 34.0% had low bone density and 13.5% had porous bones.
Among the women, 6,540 reported experiencing fragility fractures.
Specifically, 38.5% were distal forearm fractures and 8.4% were hip fractures, with 66.8% of the non-vertebral fracture patients being under the age of 65.
This data shows that as your estrogen levels decline during menopause, your risk of bone loss, especially in the spine, hips, forearms, and wrists, increases.
Postmenopause
Postmenopause is the stage of life that follows menopause, marking the end of a woman’s reproductive years. It begins once a woman has gone 12 consecutive months without a menstrual period and lasts for the rest of her life. (14)
During this ongoing phase, women may experience bone loss, with approximately 50% of their trabecular bone—which has higher metabolic activity and sensitivity to hormonal changes—and about 30% of their cortical bone being lost over a lifetime. (15)
This total loss is not immediate; rather, it occurs gradually, with nearly half the trabecular bone loss happening in the first ten years after menopause.
A study published in The New England Journal of Medicine found that older postmenopausal women are at increased risk of hip and vertebral fractures due to declining bone mineral density (BMD), a consequence of reduced estrogen levels. (16)
Researchers studied 33 women who experienced hip fractures and 138 women who had vertebral fractures, compared with randomly selected control women from the same population.
The results showed that women with very low levels of the hormone estradiol or estrogen (below 5 pg/mL) had a 2.5 times higher risk of hip and vertebral fractures than those with normal estradiol levels.
Moreover, higher levels of sex hormone-binding globulin (SHBG), particularly those at 1.0 µg/dL or more, were linked to a greater fracture risk—2.0 times for hip fractures and 2.3 times for vertebral fractures.
Not only that, but women with both low estradiol and high SHBG faced an even greater risk, with risk ratios reaching 6.9 for hip fractures and 7.9 for vertebral fractures.
In other words, postmenopausal women with low estradiol concentrations and high SHBG levels are at an increased risk of hip and vertebral fractures.
This poses an important question: how does low estrogen increase the risk of bone fragility?
5 Ways Low Estrogen Levels Contribute to Bone Loss
Estrogen is more than just a sex hormone; it also helps regulate bone remodeling and maintain bone density. However, a deficiency can leave your bones more susceptible to increased resorption, which weakens bones and raises fracture risk.
But why does this happen? Here are five ways that low estrogen levels can lead to weaker, more porous bones.
Increases Sensitivity of Bone Mass to Parathyroid Hormone (PTH)
Inadequate estrogen levels can increase the sensitivity of bone mass to parathyroid hormone (PTH).
PTH is produced by the four small parathyroid glands located in the neck, which are important in regulating calcium levels in the blood for the proper functioning of nerves, muscles, and the heart. (17)
When calcium levels in the blood drop too low, parathyroid hormone (PTH) is released into the bloodstream. (18)
It signals the bones to release stored calcium, instructs the intestines to absorb more calcium from dietary sources, and prompts the kidneys to conserve calcium, reducing its excretion in urine.
These processes work together to restore calcium levels in the bloodstream and maintain overall bone health.
However, during menopause, when estrogen levels decline significantly, bones become more sensitive to PTH.
This heightened response accelerates calcium release from bones, leading to enhanced bone breakdown and a loss of bone density.
The decline in estrogen also increases osteoclast activity while slowing osteoblast activity. As a result, bones lose density, becoming weaker and more prone to fractures.
Reduced Calcitonin Production
Calcitonin is a hormone produced by the parafollicular cells (C-cells) of the thyroid gland that helps regulate calcium levels in the body. (19)
It works by lowering blood calcium levels by inhibiting the activity of osteoclasts, the cells responsible for breaking down bone tissue. This helps maintain bone density and prevent weak and brittle bones. (20)
Estrogen may influence calcitonin activity. However, when estrogen levels drop during menopause, it can contribute to reduced bone-protective effects of calcitonin. (21)
This decline may result in increased bone resorption (the process of breaking down bone), which can further exacerbate the risk of bone loss, as the breakdown of bone outpaces its formation. (22)
Low Calcium Absorption
When estrogen levels are low, your body’s ability to absorb calcium in the intestines decreases.
Calcium absorption is the process by which your intestines take in calcium from food, essential for maintaining bone health and balanced calcium levels in the body.
Estrogen helps facilitate calcium absorption partly by influencing vitamin D receptor expression, which promotes the production of transport proteins like calbindin. (23)
Calbindin binds to calcium, making it easier for the body to absorb this critical mineral.
This is especially important for postmenopausal women who may not be getting enough calcium in their diets. (24)
However, as estrogen levels drop during menopause, intestinal calcium absorption decreases.
This reduction can compromise bone health, increasing the risk of brittle, porous bones, particularly in areas like the hips and spine, especially if dietary calcium intake is insufficient. (25)
Increased Calcium Excretion by the Kidneys
Calcium excretion refers to the process by which the kidneys filter excess calcium from the blood and remove it through urine. (26)
This balance is important for maintaining healthy calcium levels in the body, which supports bone health, nerve function, and muscle contraction.
Estrogen helps maintain this balance by influencing renal calcium reabsorption, partly through its effects on vitamin D metabolism. (27)
When estrogen levels are normal, it encourages the kidneys to retain calcium, reducing the amount lost in urine. (28)
However, when estrogen levels drop during menopause, the kidneys excrete more calcium than necessary. (29)
This increased calcium excretion can lead to lower calcium availability for bones, contributing to weaker bones and a higher risk of fractures.
Increased Oxidative Stress in Bone Health
Estrogen also supports bone health through its potent antioxidant effects. (30)
It helps reduce oxidative stress, which can harm bones, and regulates osteoclast activity, reducing excessive bone resorption.
It also helps support osteocytes, the cells that maintain bone structure, reducing their susceptibility to oxidative stress and apoptosis. (31)
However, during menopause, as estrogen levels decline, women experience increased oxidative stress and osteoclast activity, resulting in weaker and more brittle bones. (32)
Oxidative stress happens when there are excessive reactive oxygen species (ROS) in the body. High levels of ROS can cause osteoblasts (the cells that build new bone) and osteocytes to become less active or more prone to apoptosis. (33)
This imbalance causes more bone to be broken down than is being formed, leading to a loss of bone mass.
In this case, how can you support bone health during menopause, when there’s a huge decline in estrogen levels?
How to Support Bone Health During Menopause
During menopause, maintaining bone health is crucial to lowering the risk of falls and fractures. Regardless of your stage in this transition, you should start prioritizing your bone strength for a healthy, active future.
What can you do to support your bone health, especially during menopause?
Eat Phytoestrogen-Rich Foods
Phytoestrogens are natural compounds found in plants that can mimic some effects of estrogen in the body. (34)
These nutrients bind to estrogen receptors, which may help provide mild estrogenic effects and support bone health to a certain extent, potentially managing symptoms associated with low estrogen, such as hot flashes.
Foods high in phytoestrogens include flax, various nuts and legumes, tempeh, and edamame, fruits like blackberries, peaches, and dried apricots; and cruciferous vegetables including broccoli, Brussels sprouts, and cauliflower.
Exercise Regularly
Engaging in regular physical activity, particularly strength-training exercises, can help maintain bone density and support hormonal health, including estrogen levels. (35)
For example, activities like walking and resistance training apply mechanical stress to bones, stimulating osteoblasts (bone-building cells) to increase bone density and strength. (36)
Jumping can also promote bone growth and support. This weight-bearing activity helps stimulate bone density, making bones stronger and more resilient. (37)
A great way to start is by practicing jumping onto a step. This exercise not only enhances your strength and coordination but also provides a safe way to incorporate jumping into your routine.
As you become more comfortable, you can gradually increase the height of the step or the intensity of your jumps.
However, before you begin any exercises, make sure to consult your doctor or the Bone Coach Team to help you create a personalized exercise plan that’s both safe and beneficial for your bone health.
This ensures that you’re engaging in activities that promote strength and stability while minimizing the risk of injury.
Manage Stress
Chronic stress triggers the release of cortisol, a hormone that can disrupt the delicate balance of sex hormones, including estrogen. (38)
Elevated cortisol levels can indirectly affect estrogen balance and exacerbate menopausal symptoms, potentially contributing to bone loss. (39)
Fortunately, engaging in stress management practices like yoga, meditation, and deep breathing can help maintain healthy cortisol levels. (40)
This is especially important during menopause when estrogen levels lower, as balanced cortisol levels can support overall hormonal equilibrium.
By reducing stress, these practices may support bone health and alleviate some menopause-related symptoms.
Consider Bioidentical Hormone Replacement Therapy (BHRT)
Bioidentical hormone replacement therapy (BHRT) can also support bone health, especially in postmenopausal women. As estrogen levels naturally decline during menopause, the risk of porous bones increases due to an imbalance between bone resorption and formation. (41)
BHRT works by replenishing estrogen levels, which helps reduce osteoclast activity (cells that break down bone) and supports osteoblast function (cells responsible for building new bone).
BHRT can also help maintain bone mineral density (BMD), which is critical for preventing bone loss. It not only increases BMD but also reduces bone turnover, particularly in postmenopausal women.
By stabilizing hormone levels, BHRT can help reduce the risk of fractures and bone injuries related to estrogen deficiency.
Before starting BHRT, it’s best to consult with your doctor, naturopathic doctor, or functional medicine practitioner to determine if it's the right choice for you.
Estrogen helps prevent bone loss, while progesterone, testosterone, and DHEA support bone building. Although BHRT isn’t for everyone, it could be a valuable addition to the wellness plan of those who could benefit from it.
Take Vitamin E
To ensure your bones remain healthy and strong during menopause, it’s crucial to include a variety of bone-supporting nutrients in your daily diet.
Aside from calcium and vitamin D, which support bone strength, you may also want to take vitamin E, an often overlooked nutrient that helps protect bones from damage due to oxidative stress. (42)
This potent antioxidant helps reduce oxidative damage in bone cells and contributes to lowering bone resorption, the process by which bones break down.
Moreover, vitamin E can suppress the production of pro-inflammatory cytokines, such as interleukin-1 (IL-1) and interleukin-6 (IL-6), which are linked to increased bone loss. (43)
By reducing these inflammatory markers, vitamin E creates a more favorable environment for bone formation.
However, not all vitamin E supplements are created equal.
Many vitamin E products primarily contain tocopherols, which may have a less pronounced effect on bone health due to their lower antioxidant capacity.
Moreover, high doses of certain tocopherols can interfere with vitamin K’s role in bone metabolism, potentially affecting bone density, as evidenced in a study published in the Journal of Nutrients. (44)
It may also hinder the absorption of other beneficial vitamin E isomers, such as tocotrienols, which have been shown to promote bone health more effectively.
If you want to maximize the bone health benefits of Vitamin E, choose a supplement that contains pure tocotrienols, a subgroup of vitamin E that is more effective than tocopherols at neutralizing free radicals and protecting cells from oxidative damage. (45)
The good news?
Annatrol™ Bone Support by Healthy Bones Co. contains DeltaGold® tocotrienol derived from annatto, which is recognized as the only known plant source of tocotrienols with virtually no tocopherols.
This nutrient supports healthy bones by protecting them from oxidative stress associated with aging, which can damage bone tissue.
In a 12-week study involving 87 postmenopausal women, it was found that those who received DeltaGold® annatto tocotrienol at dosages of 300 and 600 mg daily experienced decreased bone resorption and improved bone formation. (46)
The participants also showed a nearly 100% increase in the BALP/NTX ratio, a measure of bone remodeling, after 12 weeks, along with a reduction of 13-24% in the RANKL/OPG ratio, indicating decreased bone resorption compared to significant increases in the placebo group.
This suggests that these women were able to strengthen their bones even during postmenopause when their estrogen levels were at an all-time low.
Not only that, but Annatrol™ Bone Support also contains 300 mg of geranylgeraniol (GG), a compound important for synthesizing vitamin K2 (MK-4), which plays a crucial role in effective calcium transport to the bones. (47)
MK-4 is essential for bone repair and maintenance, as it activates proteins, such as osteocalcin and matrix Gla-protein, that regulate calcium utilization in the body. (48)
This not only helps build stronger bones but also prevents the accumulation of calcium in soft tissue, such as the arteries, supporting both bone and cardiovascular health. (49) (50)
By replenishing GG levels, you can help combat age-related physical decline, support structural integrity, and reduce skeletal muscle fatigue.
Therefore, if you want to support bone health during menopause and maintain strong bones for a healthy, active future, try Annatrol™ Bone Support!
Moreover, just two pea-sized capsules of Annatrol™ Bone Support offer other health benefits beyond supporting bone health.
- Helps maintain skin and eye health*
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- Promotes regulation of healthy metabolic functions*
- Supports insulin sensitivity and normal glycemic control*
- Promotes a healthy inflammatory response*
- Supports antioxidant status*
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- Helps mitochondrial function and cellular energy generation*
- Supports hormone synthesis*
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Support healthy and strong bones before, during, and after menopause.
Try Annatrol™ Bone Support today.
