The Menopause Bone Check Women Forget to Ask For

Menopause has a way of making symptoms loud. Hot flushes, broken sleep, mood shifts and brain fog tend to get the attention because they interrupt daily life.

Bone loss is different. It can happen quietly.

You usually cannot feel your bone density dropping. There may be no warning sign, no ache and no obvious change in how your body feels. For many women, the first clue is a fracture after a minor fall, bump, or movement that should not have caused that much damage.

That is why bone health deserves a bigger place in the menopause conversation.

Australian health information from Better Health Victoria notes that women lose up to 10% of their bone density in the first five years after menopause. The Australasian Menopause Society also explains that falling oestrogen after menopause accelerates bone loss.

The check women often forget to ask for is simple: “Do I need a bone health assessment?”

That may include a fracture risk review, a calcium and vitamin D check, questions about family history and in some cases, a bone density scan.

Why menopause affects bones

Bone is living tissue. It is constantly being broken down and rebuilt. Oestrogen helps keep that process in balance.

As oestrogen levels fall during menopause, bone breakdown can start to happen faster than bone rebuilding. Over time, bones may become less dense, weaker and more likely to fracture.

This matters because osteoporosis is often called a silent disease. You may not know your bones are weaker until a fracture happens.

The Australian Institute of Health and Welfare estimated that around 853,600 Australians were living with osteoporosis or osteopenia in 2022, and notes that the true number is likely higher because many cases are undiagnosed.

Healthy Bones Australia has also described poor bone health as a major issue in Australians aged over 50, estimating millions of people are living with osteoporosis or osteopenia.

Why midlife is the time to ask

Many women think bone density is something to worry about much later. The problem is that the groundwork is laid earlier.

Perimenopause and the early postmenopause years can be an important window for prevention. This is when hormone changes, sleep disruption, lower activity, dieting, lower protein intake, reduced strength training and vitamin D deficiency can all start to stack up.

You do not need to wait until you have a fracture to start the conversation.

A GP can help review your risk based on your age, menopause stage, family history, previous fractures, medicines, weight, smoking, alcohol intake, calcium intake, vitamin D, physical activity and other health conditions.

The Royal Australian College of General Practitioners and Healthy Bones Australia guideline recommends fracture risk assessment tools, including FRAX, to help identify people who may need further assessment or treatment.

What is a bone density scan?

A bone density scan, often called a DEXA or DXA scan, measures bone mineral density. It is usually done at the hip and spine, where fractures can have serious consequences.

The scan is quick, low-dose and non-invasive. It does not hurt, and you stay clothed while the machine passes over the body.

A DEXA result can show whether your bone density is in the normal range, whether you have osteopenia, or whether you meet the threshold for osteoporosis.

Osteopenia means bone density is lower than normal, but not low enough to be classed as osteoporosis. It is still useful to know because it gives you time to act before risk increases.

Who should ask about a bone check?

Not every woman needs a bone density scan the moment her periods stop, but many should ask about risk.

It is worth speaking with your GP if you:

• had early menopause before age 45
• had your ovaries removed
• have had a fracture from a minor fall or bump
• have a parent who broke a hip
• have a family history of osteoporosis
• have taken oral corticosteroids for several months
• smoke, or have smoked for a long time
• drink heavily
• have a low body weight
• have lost height, or developed a stooped posture
• have coeliac disease, inflammatory bowel disease, rheumatoid arthritis, kidney disease, thyroid disease, or another condition linked with bone loss
• have low vitamin D, low calcium intake, or limited sun exposure
• have a history of eating disorders, long-term dieting, or missed periods
• are on treatments that can affect bone health, including some breast cancer therapies

If you are unsure, ask anyway. “Do I have any risk factors for osteoporosis?” is a good place to start.

The HRT question

Menopausal hormone therapy, or MHT, is not the right choice for everyone, but bone health is one reason it is back in the conversation.

The Australasian Menopause Society states that MHT reduces bone loss and fracture risk, and notes it is most suitable for women under 60, with the added benefit of relieving menopause symptoms such as hot flushes.

New research presented at the Endocrine Society’s 2026 annual meeting also found that postmenopausal women using menopausal hormone therapy had a 69% lower risk of low bone mineral density than women not using it. The study was presented as meeting research, so it should be seen as part of a growing conversation rather than the final word.

The practical takeaway is not that every woman should start MHT for bone health. It is that bone health should be part of the discussion when weighing up menopause treatment options.

If you have hot flushes, night sweats, early menopause, high fracture risk, or concerns about bone density, ask your GP whether MHT is appropriate for you, and how the benefits and risks apply to your personal health history.

What else protects bones after menopause?

Bone health is not only about calcium.

A bone-smart plan usually includes a few key habits working together.

Protein matters because bones and muscles work as a team. Stronger muscles help support balance, movement and fall prevention. If you are not eating enough protein, or you are dieting aggressively, your bones may not be getting the support they need.

Calcium matters because it is a building block for bone. Good sources include dairy foods, calcium-fortified plant milks, calcium-set tofu, tinned salmon or sardines with bones, almonds, tahini and leafy greens.

Vitamin D helps the body absorb calcium. Sun exposure, diet and supplements may all play a role depending on your levels, skin type, lifestyle and location.

Strength training matters because bone responds to load. Lifting weights, using resistance bands and doing bodyweight exercises can help bones and muscles stay stronger. Walking is good for general health, but resistance training adds the kind of challenge bones need.

Balance training matters too. Falls are a major driver of fractures, so exercises that improve balance, coordination and lower-body strength can be protective.

Alcohol and smoking also matter. Smoking is linked with poorer bone health, and heavy alcohol use can increase fracture risk.

What to ask your GP

If you are in perimenopause, menopause, or postmenopause, consider bringing bone health into your next appointment.

Useful questions include:

• Do I have any osteoporosis risk factors?
• Should I have a fracture risk assessment?
• Do I need a DEXA scan?
• Should we check my vitamin D?
• Am I getting enough calcium and protein?
• Does my medication affect my bones?
• Would MHT help my symptoms and bone health, or is it not suitable for me?
• Should I see a physiotherapist, exercise physiologist, dietitian, endocrinologist, or menopause specialist?
• How often should we reassess my bone health?

If you have already had a fracture after a small fall or minor bump, do not dismiss it as bad luck. Ask whether it could have been a fragility fracture.

The bottom line

Bone loss after menopause can be silent, but it is not inevitable that you only find out after a fracture.

The most important move is asking earlier. A bone health check can help you understand your risk, decide whether you need a scan and make a plan while prevention is still possible.

Menopause care should not stop at hot flushes. Your future strength, mobility and independence deserve a place in the appointment too.