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When you’re going through menopause, you might expect vasomotor symptoms like hot flashes and night sweats. You may anticipate having vaginal dryness and mood changes during menopause.

But did you know another common menopausal symptom is losing bone density?

Here’s what you need to know about keeping your bones healthy during menopause and beyond.

What Is Osteoporosis?

Osteoporosis is a disease in which bones lose density and mass. They become brittle and weak and can fracture easily. Osteoporosis occurs more often as people age.

According to the National Institute on Aging, osteoporosis affects about one in five women over 50. It affects about one in 20 men in the same age group.

The hormonal changes of menopause speed up bone loss in women. Osteoporosis is a major cause of fractures in postmenopausal women.

Risk factors for osteoporosis

Osteoporosis can occur at any age and in all races and ethnic groups. But the following risk factors make osteoporosis more likely:

• Being underweight or fine-boned.
• Being a non-Hispanic white or Asian woman.
• Changing hormone levels, especially when estrogen levels start dropping in perimenopause.
• A diet lacking in calcium and/or vitamin D.
• Family history of broken bones or osteoporosis.
• Having a broken bone before age 50.
• Having certain medical conditions, such as diabetes, rheumatoid arthritis, human immunodeficiency virus (HIV), or acquired immunodeficiency syndrome (AIDS).
• Heavy alcohol use.
• Long-term use of some medications. These include corticosteroids, some cancer medications, proton pump inhibitors, and antiepileptic medicines.
• Premature menopause, when your periods stop before age 40. Premature menopause can happen naturally or when you have your ovaries removed through surgery. People in premature menopause often take hormone replacement therapy, or HRT.
• Sedentary lifestyle.
• Smoking.

Osteoporosis Symptoms

Osteoporosis is a “silent” disease that rarely has symptoms. You may not know you have it until you break a bone.

Fractures from osteoporosis can occur in any bone. But they happen most often in the spine, hip, and wrist.

Fracturing a bone doesn’t take much if you have osteoporosis. A minor fall that wouldn’t cause a break in a healthy bone can fracture a bone with osteoporosis. Even everyday movements like coughing, bending, or lifting an object may cause a bone to break.

Diagnosing Osteoporosis

If you’re a woman over 65, you should get screened for osteoporosis. If you’re under 65 but at greater risk for osteoporosis, you should get screened.

Your doctor will run a bone density test to measure the strength of your bones. This test, called a DXA scan, measures bone density at the heel, spine, hip, hand, or wrist.

You lie down for up to 10 minutes during the test while a special machine scans your body. The amount of radiation in the test is less than in a routine chest x-ray.

The test result, called a T score, will show whether you have osteoporosis. It’ll also show if you have osteopenia, a low bone density that’s less severe than osteoporosis.

Health care providers use the ICD-10 code M81 to classify and track osteoporosis cases. This coding helps with diagnosis, treatment planning, and insurance documentation.

Your doctor may also use other screening tools, such as questionnaires, a physical exam, and ultrasounds. These can help predict your risk of breaking a bone.

How to Prevent Osteoporosis

The earlier you pay attention to bone health, the better. If you have risk factors for osteoporosis, taking steps to preserve your bones is especially important.

If you’re in perimenopause (the transitional phase before menopause) and have risk factors, ask your doctor about getting a bone density scan.

Here are some ways to keep your bones strong and healthy.

Calcium and vitamin D

You can help keep your bones strong by getting proper nutrition.

Calcium helps build and maintain healthy bones.

Vitamin D helps the body absorb calcium. Your body will naturally produce vitamin D when exposed to sunlight.

Good food sources of these nutrients include:

• Almonds.
• Breads, juices, and cereals fortified with calcium and vitamin D.
• Broccoli.
• Dark leafy greens.
• Egg yolks.
• Fish (like sardines and anchovies) with the bones.
• Skim milk.
• Yogurt and cheese.

Getting nutrients from food whenever possible is best. But you may need to take calcium and vitamin D supplements. Talk to your doctor about whether supplements are right for you.

Exercise

Bones consist of living tissue, so exercise can strengthen them like any other body part. For healthier bones, try:

• Strength training — You don’t need to lift heavy weights at the gym to strengthen your bones and muscles. Try weight resistance with your body, handheld weights, or resistance bands.
• Weight-bearing exercise — This includes anything you do while standing because it makes your bones and muscles fight gravity. Jogging, dancing, stair climbing, and even brisk walking are all weight-bearing activities.
• Workouts for balance — Workouts help prevent falls. Build up your flexibility and balance with non-weight-bearing exercise. Try yoga, Pilates, or tai chi to improve your balance and posture.

Lifestyle changes

You can reduce your risk of osteoporosis if you:

• Don’t smoke — If you smoke, take steps to quit. Avoid secondhand smoke, which is often just as dangerous.
• Limit alcohol — Women should limit alcoholic drinks to one per day.

Osteoporosis Treatment

You can help slow bone loss by taking the same steps you would to prevent osteoporosis. In addition, your doctor may recommend hormone therapy or medication.

Estrogen therapy may help strengthen bones and prevent osteoporosis. It’s most effective if taken early in menopause. You can talk to your doctor about the pros and cons of hormone therapy.

Your doctor may also recommend taking medicine for osteoporosis. These include:

• Drugs to help rebuild bone — These include synthetic parathyroid hormone and a protein-inhibiting drug called sclerostin.
• Drugs to slow down bone loss — This list includes bisphosphonates, calcitonin, and other medications that change how estrogen works in the body.

You may take these medications by mouth, injection, nasal spray, or skin patch. You may take some daily, monthly, yearly, or just a few times a year. Ask your doctor what will work best for you.

Your doctor will order another DXA test to see whether the treatment works. You should see a difference after at least 18 months of treatment. Your follow-up scan may happen one to three years after you start treatment.