Osteoporosis and Menopause: How to Protect Your Bones

Let’s talk about bones. Not the most glamorous topic, I know. But if you’re navigating midlife and menopause, it’s a conversation worth having—because your bones are paying attention to all the hormonal changes happening under the surface.

Here’s the truth: menopause is natural, but osteoporosis isn’t. Menopause does affect your bones, making them more fragile and more likely to fracture. And while menopause doesn’t cause osteoporosis, it definitely speeds up bone loss.

The good news? There’s a lot we can do to reduce the risk.

How Can I Prevent Osteoporosis During Menopause?

The menopausal transition is a critical window for bone health. As estrogen levels decline, bone loss naturally accelerates so this is a key time when the right nutrition, movement, and lifestyle choices can meaningfully slow that process and reduce fracture risk.

Am I at risk for osteoporosis?

Short answer? Quite possibly.

About half of women over 50 will either develop postmenopausal osteoporosis or be at risk for it.

Risk factors include:

• Age: Bone loss picks up speed as we get older.
• Family history: Genetics do play a role.
• Race: White and Asian women are at greater risk.
• Early menopause: More years post-menopause = more opportunity for bone loss.
• Lifestyle: Smoking, lack of movement, and excess alcohol don’t do our bones any favors.
• Chronic dieting: This one doesn't get enough attention and it affects a lot of women

Take this quiz to get a sense of your personal risk.

Signs of Osteoporosis (That Often Show Up Too Late)

Here’s the tough part: osteoporosis is often called a “silent disease” because many people don’t know they have it until they break a bone.

According to Osteoporosis Canada, fractures from osteoporosis are more common than heart attack, stroke and breast cancer combined!

Other red flags include:

• Height loss
• Back pain
• Stooped posture
• Bone deformities (like spinal curvature)

The only way to truly know if you're losing bone mass? A bone density scan. Definitely something to talk about with your healthcare provider.

What is the best diet for osteoporosis?

A Mediterranean-style diet is rich in whole foods, fruits, vegetables, legumes, nuts, and healthy fats—plus key bone-supportive nutrients like calcium and vitamin D. Research suggests this way of eating may help preserve bone density and reduce fracture risk.

Key Nutrients for Bone Health

1. Calcium

Calcium is a foundational nutrient for bone health and osteoporosis prevention.

About 99% of the calcium in your body is stored in your bones and teeth, where it provides strength and structure. Calcium also plays essential roles in muscle contraction, nerve signaling, and heart rhythm.

Because those functions are critical, your body will always keep blood calcium levels stable—even if that means pulling calcium out of your bones when intake is low. Over time, this can weaken bone and increase osteoporosis risk.

On top of that, your body becomes less efficient at absorbing calcium from food, which makes it even trickier to maintain strong bones.

How Much Calcium Do You Need?

• Women ages 19–50: ~1,000 mg per day
• Women over 50: ~1,200 mg per day

Food-First Calcium Sources

Food sources are ideal because they provide calcium alongside other bone-supportive nutrients. Common options include:

• Milk, yogurt, cheese (and calcium-fortified plant milks)
• Sardines or canned salmon with bones
• Calcium-set tofu
• Leafy greens like kale and collards
• Broccoli
• Almonds
• Beans, including black-eyed peas
• Dried figs
• Calcium-fortified foods (check labels)

You don’t need to get all 1,200 mg at once—spreading calcium-rich foods across the day works best.

👉 Read more about calcium and if you should supplement here: How Calcium and Vitamin D Work Together for Bone Health After Menopause

👉 Curious how much calcium you’re actually getting? Try this free calcium intake calculator.

👉 Looking for non-dairy options? Read Calcium Without the Cow for plant-based sources.

2. Vitamin D

Vitamin D is essential for calcium absorption and bone mineralization. Even with adequate calcium intake, low vitamin D can limit how well calcium is used.

General guidance:

• National Institutes of Health: 600 IU (ages 19–69), 800 IU (70+)
• Osteoporosis Canada: 800–2,000 IU daily for adults over 50

Food sources include fatty fish, egg yolks, fortified foods, and UV-exposed mushrooms.

Vitamin D is also produced in our body when our skin is exposed to the sun’s rays. But in Northern countries, we don’t always get as much sun as we need to make adequate amounts. As well, our skin’s ability to make vitamin D declines as we age.

I recommend a daily supplement of 1000IU/d in addition to eating vitamin D-rich foods.

👉 Read more: How Calcium and Vitamin D Work Together for Bone Health After Menopause

3.Vitamin K2

Vitamin K2 plays a supporting role in bone health by helping calcium bind properly into bone.

It activates a protein called osteocalcin, which allows calcium to be incorporated into the bone matrix. Without enough vitamin K2 activity, calcium can still circulate in the body—but may not be used as efficiently for bone building.

This distinction matters because vitamin K comes in different forms. While vitamin K1 (found mainly in leafy green vegetables) is important for blood clotting, vitamin K2 is the form most often discussed in relation to bone health.

Vitamin K2 is found in fermented foods and some animal products, such as:

• Natto (fermented soybeans)
• Aged cheeses
• Egg yolks

There is no official intake recommendation for vitamin K2 specifically for osteoporosis prevention, and vitamin K deficiency is uncommon.

More evidence is needed to determine if vitamin K supplementation can help prevent weakening bones. One review showed that postmenopausal women and those who already have osteoporosis lowered their chance of getting a fracture with vitamin K supplements.

👉 For a deeper look at vitamin K1 vs K2, food sources, supplements, and who might benefit most:
Vitamin K2 for Bone Health in Menopause

4. Protein

Protein provides the structural framework bones are built on and helps preserve muscle, which reduces fall and fracture risk.

Increased protein intake has been associated with greater bone density, a slower rate of bone loss, and a reduced risk of hip fractures.

Most women benefit from at least 1.0–1.2 g/kg/day during menopause, with higher needs if strength training regularly.

Including more plant-based sources of protein—like tofu, soy milk, and edamame—is beneficial not just for overall health but may also support bone density.

👉 Read more: Protein and Bone Health in Menopause and Does Soy Help Bone Health in Menopause? A Dietitian’s Take

5. Magnesium

Magnesium supports vitamin D activation, calcium balance, and bone remodeling. Low intake has been linked to lower bone density, particularly at the hip.

👉 Read more here: Magnesium and Zinc for Bone Health in Menopause

6. Fiber

Fiber doesn’t build bone directly, but emerging research suggests it may support bone health by improving mineral absorption and reducing inflammation — especially relevant after menopause.

👉 Check out: Can Fiber Support Bone Health After Menopause?

Best Exercise for osteoporosis

Like the rest of your body, your bones thrive on movement. Every time you move, your muscles pull on the bones to get you going. The more you stress your skeleton with movement, the more your body responds by making your bones stronger and denser.

There are three main types of exercise that support bone health:

Weight-bearing exercises: These are activities where you work against gravity while on your feet—walking, running, dancing, and sports like tennis or pickleball.

These types of movement are particularly good for slowing mineral loss in your hips, legs, and spine.

Swimming and cycling are great for cardiovascular health, but they don’t provide the bone-strengthening impact that weight-bearing exercise does, so it’s important to mix it up.

Resistance training: Strength training helps maintain and build both muscle and bone.

Using free weights, machines, or resistance bands creates a load for your muscles to work against, which stimulates your bones to stay strong. As we age—and especially after menopause—our muscle fibers shrink in both size and number.

Strength training is KEY to counteracting this natural loss.

Posture and core exercises: These movements target the muscles in your upper back and core. They’re crucial for reducing back pain, improving balance, and preventing spinal compression fractures.

Yoga and Pilates can be great here, but even simple daily posture work can make a difference.

So, how much should you be doing? Well, that’s still being figured out.

A recent meta-analysis reviewed over 75 studies and couldn’t pin down one magic formula. Different programs, different participants, different outcomes.

The “use it or lose it” mantra really applies. Something is better than nothing.

Most health guidelines suggest aiming for an accumulation of 150 minutes of weight-bearing activity per week, along with 2–3 strength training sessions. That’s a solid goal to start with.

Things to Limit (Sorry in Advance)

Certain habits can accelerate bone loss. These are often things we don’t think of as “bone issues,” but the research shows they matter:

Smoking: This is a big one. Smoking affects bone health in multiple ways. It lowers peak bone mass, accelerates bone loss across your lifespan, and especially speeds up loss after menopause.

Alcohol: The science here is still evolving, but we do know that chronic, heavy alcohol use compromises bone strength, reduces bone density, and interferes with the bone’s ability to repair itself.

Even moderate alcohol consumption is a bit murky—some studies suggest a small benefit for bone mass, while others show no benefit or potential harm. Health Canada’s updated guidelines suggest keeping it to two standard drinks per week—a big shift from older recommendations.

Coffee: Ah yes, coffee. A high caffeine intake may slightly increase calcium loss and fracture risk. A 2017 meta-analysis found that women with high coffee intake had a higher fracture risk than those with lower intake, and that each additional cup per day may nudge up that risk.

Aim to limit to four cups (250 ml each) or less per day.

On a brighter note, tea—especially green or black—may actually have bone-protective benefits, thanks to its polyphenol content. Just try to drink it an hour away from meals so it doesn’t interfere with calcium absorption.

But its best to drink tea at least an hour outside of mealtimes, to optimize calcium intake.

You will lose some bone as you transition through menopause. That’s biology. But you don’t have to accept osteoporosis as a given. Small, intentional steps—eating well, staying active, being mindful of your lifestyle—can make a meaningful difference.

Your bones are your lifelong support system. Now’s the time to return the favour.