Menopause and osteoporosis: how to strengthen bones, prevent fractures, and stay strong and healthy

You may think of your bones as strong and unchanging — the rock-solid framework of your body. But your bones naturally change over time. During perimenopause and menopause, your bones start to need more attention and care. Declining estrogen levels in menopause can contribute to osteoporosis. But being informed about the link between menopause and osteoporosis can help you take action to protect your strength and improve bone health. 

Here, learn more about what causes osteoporosis during menopause, its symptoms, and ways to treat and prevent it and keep your bones strong — especially with exercises and advice from Hinge Health physical therapists.

Menopause starts when you haven’t had a period for 12 months. The phase leading up to it, called perimenopause, usually begins in your 40s or 50s and can last several years.

What is osteoporosis?

Osteoporosis is a condition that causes bones to become less dense and more fragile. The word osteoporosis itself means “porous bone.” In a healthy skeleton, bone has a honeycomb-like structure that provides strength and resilience. In osteoporosis, this framework becomes thinner and weaker, which can increase the risk of fractures. 

The condition develops gradually over time, often progressing without noticeable symptoms. Many factors can contribute to osteoporosis, including hormonal changes such as reduced estrogen during perimenopause and menopause, aging, certain lifestyle habits, and some medical conditions or medications. 

Osteoporosis is much more common in women and people with female anatomy than men and people with male anatomy — about 80% of the people affected are women. This is partly because women generally have lighter, thinner bones than men. After menopause, the drop in estrogen causes women to lose bone much more quickly. In the five to seven years after menopause, people can lose up to 20% or more of their bone density. Women also tend to live longer, which increases their window for developing osteoporosis.

The risk of osteoporosis is higher for people who have a small body size, a family history of osteoporosis, don’t get enough calcium or vitamin D, or don’t do regular weight-bearing activities like walking or strength exercises. Smoking and long-term use of certain medications, such as steroids, add to the risk.

“I meet a lot of people with a recent osteoporosis diagnosis, and there’s often some uncertainty and even fear,” says Maria Fernandez-Cuadrado, PT, DPT, a physical therapist at Hinge Health. There’s so much information out there and it can be confusing to know what steps to take, she says. 

“I love helping people learn that movement is medicine. There’s always something you can do to improve your bone density, no matter your age,” says Dr. Fernandez-Cuadrado.

How is osteoporosis in menopause diagnosed?

Osteoporosis in perimenopause and menopause is most often diagnosed with a bone mineral density (BMD) test, typically using Dual-Energy X-ray Absorptiometry (DXA). Here’s how to interpret your results:

• T-score of -2.5 or lower means you have osteoporosis

• T-score between -1.0 and -2.5 is called osteopenia, which signals lower-than-normal bone mass and a higher risk for osteoporosis.

• T score of -1.0 or higher means you have healthy bones for your age

Healthcare providers may also use tools like the FRAX score — which estimates your chances of a bone fracture in the next 10 years — and sometimes a Trabecular Bone Score (TBS), which offers more detail about bone quality.

Screening is recommended for all women age 65 and older, and for postmenopausal women under 65 who have risk factors such as previous fractures, early or surgical menopause, low body weight, smoking, family history, certain medications, or health conditions that affect bone strength. You may need earlier or more frequent testing if you’re at higher risk. In some cases, your doctor may also order imaging to look for hidden vertebral fractures if you’ve had a previous fracture.

“Osteoporosis is often called a ‘silent condition’ because you might not feel any different as your bones change,” says Dr. Fernandez-Cuadrado. “That’s why regular screening is so important, even if you feel fine. Being proactive gives you the best chance to catch changes early, protect your bones, and stay strong and active for years to come.”

Causes of osteoporosis in menopause

Osteoporosis during perimenopause and menopause occurs mainly because of a decrease in estrogen, along with other factors such as aging, genetics, lifestyle, and diet. Estrogen is a hormone that plays a major role in keeping bones healthy by balancing the process of building new bone and breaking down old bone. When estrogen levels fall during perimenopause and menopause, bone density decreases, which causes bones to become weaker over time.

This process usually starts about three years before your last period, with bone loss happening most rapidly in the first five to seven years after menopause. The drop in estrogen also causes other changes inside the bone, making the structure weaker and allowing more inflammation, which can further increase the chance of fractures.

Other factors can add to your risk of osteoporosis, such as your genes, not building enough bone during your younger years, taking certain medications, excessive alcohol use, and a diet that doesn't support bone health. Although bone loss is fastest in the years right around menopause, the rate of loss usually slows down and becomes more gradual after menopause.

“When it comes to osteoporosis, catching risks early and taking action can really make a difference in your bone health for years to come,” says Dr. Fernandez-Cuadrado. Whether menopause happens naturally or as a result of surgery, the sudden drop in estrogen can lead to faster bone loss, she explains. “But there’s always something you can do. Taking small steps now, no matter your age, and having conversations with your healthcare team can go a long way toward protecting your bones and lowering your risk of future fractures.”

Symptoms of osteoporosis in menopause

Most people with osteoporosis have no symptoms for years, which is why it’s often called a “silent” condition. Many only find out they have it after a minor bump or fall results in a bone fracture, which can sometimes be the first sign that their bones have become less strong. Some signs may point to changes in your bone health, including shifts in posture, pain, fractures, decreased bone density, or feeling weaker or less stable. Here’s what to look for:

• Loss of height. Losing height gradually can signal underlying fractures of the spine.

• Stooped posture or spinal curvature. A hunched back or “dowager’s hump” develops when bones in the spine collapse and curve forward.

• Back pain due to vertebral compression. Sudden or ongoing back pain can be a red flag for spinal (vertebral) fractures

• Fractures. If you break a bone after a minor fall or bump, osteoporosis might be the culprit, especially if the fracture happens in the hip, wrist, or spine.

• Weakness or instability when walking. Muscle loss and frailty in menopause increase the risk of falls, a leading cause of fractures.  

• Pain or tenderness in bones, even without injury. Some people notice bone or joint pain due to subtle musculoskeletal changes of menopause.  

• Decreased bone density seen on a DXA scan.  

“Sometimes the most helpful clues about your bone health come from people who don’t see you every day,” says Dr. Fernandez-Cuadrado. “A friend or family member might mention you’re walking differently or that your posture has changed.” Our bodies are fantastic at making little adjustments — so you may not even notice things like losing height or shifting your weight from one side to the other, she explains. “Someone who sees you less often, or a physical therapist, can often pick up on these subtle cues.”

Treatments for osteoporosis in menopause

Treating osteoporosis is focused on keeping your bones strong and helping you avoid fractures. It can include physical therapy and targeted exercises, maintaining an active lifestyle, medications that slow bone breakdown or build new bone, and nutritional support to get enough calcium and vitamin D. Your provider can help you choose treatments that fit your bone density, risk of fractures, and overall health. Here’s more on menopause osteoporosis treatments:

Physical therapy and targeted exercises  

Targeted exercises — especially weight-bearing, resistance, and balance movements — can help improve bone density, reduce pain, and lower your risk of falls. Examples include activities like squats, bent-over rows, standing marches, and single-leg balance exercises (see exercises below). You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit. 

Stay active

Targeted osteoporosis exercises are designed to strengthen bones and build muscle, but any type of movement — such as walking, stretching, or even household chores — can help improve strength, balance, and overall bone health. Exercise routines that combine resistance training, weight-bearing activity, and balance work are the most effective because they help maintain bone density and lower your risk of falls and fractures. A physical therapist can help you find options that feel good for your body and guide you on ways to keep moving confidently.

“You don’t need a fancy gym or special equipment to get stronger,” says Dr. Fernandez-Cuadrado. Simple tools like resistance bands, small dumbbells, or even household items like cans of soup work great, she adds. “The key is to find activities you enjoy and try to carve out time for them three to five times a week.”

If you already have osteoporosis, osteopenia, or a history of spine fractures, you may need extra support to keep your movements safe and comfortable. Some exercises or activities may need to be modified to better fit your needs and help prevent falls or discomfort. A physical therapist or your healthcare provider can help you choose movements that are right for you. Always check with your healthcare provider before starting any new exercise program.

Medications

Medications can be an important component of osteoporosis management, and they fall into two categories: antiresorptives that slow bone loss, and anabolics that stimulate new bone growth. The choice of treatment depends on such factors as your bone density score, fracture history, and calculated 10-year fracture risk using tools like the FRAX score and Trabecular Bone Score (TBS). Like all medications, osteoporosis treatments can have potential side effects or risks. Your provider can help you weigh the benefits and possible drawbacks of each option and choose what’s best for you.

• Antiresorptive medications (slow bone loss). These medications help protect bones by slowing bone loss and lowering the risk of fractures. Common options include bisphosphonates (the usual first choice), denosumab (an injection given twice a year), systemic menopause hormone therapy (mainly for people who also need menopause symptom relief), raloxifene (which acts like estrogen on bone to prevent vertebral fractures), and, less commonly, calcitonin for some people who are several years past menopause.

• Anabolic medications (build new bone). These medications are used for people with very high fracture risk or those who have had multiple fractures. Options include teriparatide, abaloparatide, and romosozumab. Research shows that for people at very high risk of fractures, starting with an anabolic medication for one to two years and then switching to an antiresorptive provides extra protection against breaking bones.

Nutritional support

Eating a diet that’s rich in bone-supporting nutrients is essential for treating osteoporosis. During and after menopause, your body’s need for calcium and vitamin D goes up, so you may need higher amounts than before. Try to get at least 1,200 mg of calcium each day, mostly from foods like dairy, leafy greens, fortified alternatives, or supplements if your diet alone isn’t enough. Most people also need an extra boost of vitamin D, since it can be hard to get enough from food alone. Aim for 800–1,000 IU of vitamin D daily. Nutrients like vitamin K2 and magnesium can also play a role in supporting both your bones and muscles. Overall, choose a balanced eating pattern that includes plenty of vegetables, fruit, whole grains, lean protein, and healthy fats. Talk to your healthcare provider before starting any supplements.

Physical therapy for osteoporosis in menopause

Physical therapy is a key way to manage osteoporosis in perimenopause and menopause. It focuses on safe movement, targeted exercises, and stretches designed to relieve discomfort and support strength, posture, balance, and mobility. Physical therapy aims to help you stay confident and active while lowering your risk of fractures and falls.

A physical therapist (PT) can assess your unique movement patterns and customize an exercise program to fit your needs and goals. They can suggest modifications to your daily routines — such as how you move, lift, or carry — to help protect your bones and joints. PTs also offer guidance to improve posture and balance, build muscle and bone strength, and reduce pain or stiffness associated with menopause-related body changes.

Treatment approaches may include balance exercises, resistance and weight-bearing routines, gentle flexibility training, and education on fall prevention. If you have osteoporosis or are at high risk, your physical therapist will ensure that movements are safe and effective for your individual situation.

You can see a physical therapist in person or access care from home with a program like Hinge Health, where you may connect with a PT via telehealth or video visits.

“After a diagnosis, it’s common to feel unsure about exercise, especially if it’s been a while,” says Dr. Fernandez-Cuadrado. Having a guide makes all the difference, she explains.  “A physical therapist takes the time to work with you, build a plan that fits your needs, and help you feel empowered to protect your bones for the future.”

Best types of exercise for osteoporosis in menopause

Whether you’ve recently been diagnosed with osteoporosis or are at risk for it, you might be tempted to avoid exercise because you’re worried about being “fragile” when you exercise. But staying active is one of the most important things you can do to keep your bones strong. In fact, a 2022 review published in the British Journal of Sports Medicine found that regular weight-bearing and resistance exercise not only improves bone strength in people with osteoporosis but also lowers the risk of falls by 26%. 

While all types of movement are helpful, Hinge Health physical therapists say the following types of exercise can be especially good for osteoporosis.  

Weight-bearing exercise

Weight-bearing and higher-impact activities challenge your bones more by making your body work against gravity. While “impact” may sound intimidating, it simply refers to activities where your feet make contact with the ground, such as walking, jogging, stair climbing, or playing tennis. Dancing is also an excellent option because it combines weight-bearing movement with multi-directional resistance, encouraging your muscles to contract in different ways to support bone health.

Cycling and swimming are excellent for cardiovascular health, but because they are non-weight-bearing, they don’t directly strengthen bones. Bone responds to impact by becoming thicker and denser, so including weight-bearing activities in your routine is important for bone health. “If you enjoy cycling or swimming, you can continue those activities — just try to add some weight-bearing exercises as well for the best support for your bones,” says Dr. Fernandez-Cuadrado.

Resistance training

Resistance training (or strength training) uses either weights or your own body to work against gravity. This can include free weights, weight machines, resistance bands, or body weight exercises. Resistance bands are a particularly flexible option because they challenge your muscles as they stretch in all directions, making them a dynamic and adaptable tool for building strength and supporting bone health.

Balance and stability exercises

Exercises like tai chi, yoga, and balance training help improve coordination and prevent falls. This is very important for those with osteoporosis as falls increase the likelihood of experiencing a bone fracture. 

“As you get older, your sense of balance relies on three main systems — your eyesight, inner ear, and body awareness,” says Dr. Fernandez-Cuadrado. If any of these are not working as well as they used to, your risk of falling goes up, she explains. “That’s why practicing balance is just as important as strength or flexibility for keeping you steady and safe.”

Flexibility work 

Some people don’t think of stretching as being a part of their “workout” regimen. But stretching and flexibility work helps improve joint mobility, posture, and balance, all of which can reduce your risk of falls and fractures. When your joints are flexible, you’re able to move more freely, which reduces strain on your bones. Stretching also helps relieve stiffness and tension, promoting better circulation and making your everyday movements safer and more comfortable. 

An effective approach to strengthen bones during perimenopause and menopause is to include both resistance training and impact activities in your weekly routine. For resistance training, try to use enough weight or resistance so that each exercise feels challenging by the last few repetitions, and aim to do these exercises two to three times a week. In addition, add activities where your feet hit the ground, like brisk walking, jogging, dancing, or jumping, at least three days a week. Doing both of these regularly helps build and maintain bone strength over time.

If you already have osteoporosis, osteopenia, or a history of spine fractures, you may need extra support to keep your movements safe and comfortable. Some exercises or activities may need to be modified to better fit your needs and help prevent falls or discomfort. A physical therapist or your healthcare provider can help you choose movements that are right for you. Always check with your healthcare provider before starting any new exercise program.

Practicing these exercises regularly can play a key role in maintaining strong bones, balance, and stability during perimenopause and menopause. Moves like squats help load the hips and spine to support bone density, while bent over rows strengthen your upper back and encourage good posture. Standing marches and single leg balance exercises not only challenge your coordination and steadiness but also help train your lower body and hip flexors, making you feel more confident and reducing your risk of falls. Wall push-ups are especially useful for building wrist, arm, and shoulder strength — important protection if you ever need to catch yourself during a fall.

Exercises like the kickstand Romanian deadlift focus on single-leg balance and hip strength, offering extra support to your hamstrings, glutes, lower back, and spine. Incorporating moves like bird dog and downward dog engages your core and both upper and lower body, builds back strength, and encourages better posture — all while helping you work on balance. Tandem balance and other balance drills can be easily adjusted to your current comfort and stability level, helping you safely build strength and progress at your own pace.

Together, these exercises build muscle strength, boost bone density, and improve coordination, helping you feel more secure, steady, and capable in everyday activities. “Practicing these moves regularly can make a real difference in how confident and independent you feel in your daily life,” says Dr. Fernandez-Cuadrado.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Benefits of exercise for osteoporosis in menopause

Exercise plays a crucial role in managing osteoporosis by improving bone density, building muscle strength, boosting balance and coordination, increasing flexibility and mobility, supporting joint health, elevating mood, and reducing pain and stiffness. Here’s how:

• Improves bone density. Weight-bearing exercises stimulate bone growth, helping slow down bone loss and reduce fracture risk.

• Enhances muscle strength. Strength training builds muscles that support and protect your bones, reducing strain and injury risk.

• Boosts balance and coordination. Exercises that focus on balance can help prevent falls, a leading cause of fractures in those with osteoporosis.

• Increases flexibility and mobility. Stretching exercises improve joint flexibility, making daily movements easier and safer.

• Supports joint health. Regular activity reduces joint stiffness and promotes healthy cartilage.

• Elevates mood and mental health. Physical activity releases endorphins, which can help reduce anxiety, depression, and the emotional challenges that can come with managing osteoporosis.

• Reduces fatigue. Physical activity causes changes in your body that increase energy levels. Plus, exercise helps boost endorphins — brain chemicals that improve mood and reduce pain, which may help decrease menopause-related fatigue.

• Reduces pain and stiffness. Staying active helps alleviate stiffness and discomfort, helping improve your overall quality of life.

“You don’t have to change your life completely — just focus on taking small, actionable steps,” says Dr. Fernandez-Cuadrado. “The benefits of exercise really add up. It’s one of the best things you can do to strengthen your bones, boost your confidence, and support your overall well-being.”

How to prevent osteoporosis in menopause

To help prevent osteoporosis during menopause, it’s important to exercise regularly, maintain a healthy weight, eat a balanced diet, get enough calcium and vitamin D, avoid smoking and excess alcohol, prevent falls, get regular bone density screenings, and consider hormone therapy or other bone-strengthening medications if recommended. Here’s more on these approaches:

• Do weight-bearing and resistance exercises. Exercise is a cornerstone for bone health. Weight-bearing activities (such as walking, jogging, jumping, dancing) stimulate bone cells. Resistance training (like squats, push-ups, and bent over rows) makes both muscles and bones stronger. Combining weight-bearing and resistance activities improves bone density and reduces fall risk. Consistency is key: Aim for 30 minutes most days and a few strength sessions each week.

• Maintain a healthy weight. Being underweight or very thin makes it harder for your bones to stay strong, and it raises your risk for fractures. Light body weight means your bones don’t get as much impact from movement to help them grow stronger, and too little body fat or muscle can also affect your hormones. Eating well, moving regularly, and keeping your muscles strong can help support a healthy weight and better bone health.

• Eat a healthy diet. A 2018 study published in the American Journal of Clinical Nutrition found that a diet rich in produce, nuts, whole grains, olive oil, and fish increased hip bone density among people with osteoporosis over a 12-month period. A diet rich in these types of foods helps control inflammation, which may help protect bones. These foods are also rich in magnesium and potassium, which are needed for strong bones, too.

• Get enough calcium and vitamin D. During and after menopause, your calcium and vitamin D needs increase, so you may need more than before. Aim for at least 1,200 mg of calcium (mostly from food) and 800–1,000 IU of vitamin D daily. If you can’t meet these needs with food alone, supplements may help. Many people need extra vitamin D, in particular. Other nutrients, like vitamin K2 and magnesium, may also support bone and muscle health. Always discuss supplements with your provider to find what’s right for you.

• Get help to quit smoking. Smoking cigarettes speeds up bone loss. Research suggests that women who smoke a pack of cigarettes a day throughout adulthood have up to a 10% reduction in bone density by menopause.

• Take steps to prevent falls. No matter your bone density, it’s wise to safeguard your home to minimize tripping and fall hazards. Remove loose rugs and electrical cords. Make sure stairs and entranceways in your home are well-lit. Don’t walk on slippery surfaces, such as ice or wet floors. Talk to your doctor about any medication you take that can affect your balance, and get regular check-ups for vision and hearing.

• Cut back on alcohol. Excess alcohol reduces your ability to rebuild bone. More than two drinks a day can increase the risk of fractures.

• Get regular screenings. Regular bone density testing (DXA scan) and fracture risk assessment (FRAX, TBS) can guide you and your provider in preventive steps or treatments.

• Consider medications. Menopause hormone therapy (MHT) — especially in the early postmenopausal years — can help preserve bone structure and reduce fracture risk. For some, bone-specific medications (like bisphosphonates or newer anabolic therapies) may be recommended for osteoporosis prevention.

When to see a doctor

Osteoporosis can improve with exercise, nutrition, and other treatments, and many people see their bone density get better over time. If you have osteoporosis, it’s important to get regular medical care. This often includes seeing your healthcare provider for ongoing management and having routine bone density (DXA) scans as recommended (many people have these every one to two years). It’s also a good idea to get care if you have:

• Unexplained bone pain or tenderness

• A recent fracture from a small fall or bump

• Noticeable loss of height or a change in posture

• Sudden or persistent back pain

• Difficulty standing or walking steadily

PT tip: It’s never too late

“A lot of people feel discouraged when they get diagnosed with osteoporosis and think it’s too late,” says Dr. Fernandez-Cuadrado. “But it’s never too late to start making lifestyle changes that can protect your bone health and help prevent further bone loss.” 

Start where you are, even if that means just a few extra steps or minutes of movement each day, she suggests. “Small wins turn into big ones over time,” says Dr. Fernandez-Cuadrado. “You don’t have to do everything at once. Every little bit counts, and those small changes really do add up to stronger bones and a healthier you.”

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

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