Osteoporosis and Menopause: What You Can Actually Do About It

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.

The impact of menopause on bone health

Estrogen is a key player in bone health, and as it declines during the menopausal transition, bone loss accelerates.

In fact, the most rapid loss tends to happen in the year before your final period and continues for about three years. According to Dr. Jen Gunter in The Menopause Manifesto, some women lose as much as 3-5% of their bone mass each year during this window.

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

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.

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.

How can I prevent osteoporosis during menopause?

The menopausal transition is a great time to start making bone-friendly choices. Let’s start with food.

Eat for Your Bones

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.

Let’s break down the specific nutrients to focus on:

1. Calcium (and Supplements if Needed)

Calcium is an essential mineral that plays a vital role in preventing osteoporosis.

About 99% of our calcium is stored in our bones and teeth, where it helps provide strength and structure. But calcium isn’t just for bones—it’s also necessary for muscle contraction, nerve function, and maintaining a healthy heartbeat.

If your body isn’t getting enough calcium from your diet, it may pull calcium from your bones to keep those critical systems running, ultimately weakening your skeleton and raising the risk of osteoporosis.

Women 19-50 years old need about 1000 mg of calcium, and women over 50 need 1200 mg of calcium per day

Food sources are ideal because they come packaged with other helpful nutrients. Some top calcium-rich choices include:

1. Dairy products: Dairy products, such as milk, cheese, and yogurt, are some of the best sources of calcium. They are also a good source of other essential nutrients like protein, vitamin D, and potassium. Plant based milks are fortified with calcium and vitamin D as well.
2. Sardines: Sardines are small, oily fish that are packed with calcium. They are also a good source of protein, omega-3 fatty acids, and vitamins B12 and D.
3. Tofu: Tofu is a popular plant-based protein source that is high in calcium. It is also a good source of other nutrients like iron, and magnesium.
4. Broccoli: Broccoli is a good source of calcium, as well as other essential vitamins and minerals like vitamin C and potassium.
5. Leafy green vegetables: Dark, leafy greens, such as kale, collard greens, and spinach, are high in calcium. They are also a good source of other nutrients like fiber, vitamin K, and iron.
6. Almonds: Almonds are a good source of calcium, as well as other essential nutrients like protein, fiber, and magnesium.
7. Fortified foods: Many foods, such as orange juice, cereal, and bread, are fortified with calcium. Check the label to see how much calcium is in a serving of the food you are considering.
8. Black-eyed peas: Black-eyed peas are a good source of calcium, as well as other essential nutrients like protein, fiber, and iron.
9. Dried figs: Dried figs also give us fiber, potassium, and magnesium.

Check out this cool free calculator to see how much you are currently getting in your diet.

Looking for more non-dairy sources of calcium? Check out this post: Calcium without the Cow.

If you need to supplement, I recommend aiming for no more than 600 mg per day from supplements.

Why? Because calcium supplements have been linked to an increased risk of kidney stones and may also raise the risk of cardiovascular disease, although the research on this is still evolving and somewhat conflicting.

When using a supplement, look for the amount of elemental calcium:

• Calcium carbonate: 40% elemental; take with food.
• Calcium citrate: 21% elemental; take anytime.

Other calcium supplements, such as calcium gluconate or calcium lactate, are not recommended as they contain a very small amount of elemental calcium.

Our bodies have trouble absorbing more than 500 mg at a time so spreading out our calcium foods and supplements throughout the day is a good idea.

2. Vitamin D

Getting enough calcium is not the sole answer to keeping your bones strong.

Vitamin D is critical to your bone health as well. The body needs vitamin D to help absorb calcium from our gut so being low in vitamin D can lead can to a deficiency of calcium, even if you are taking enough.

The amount of vitamin D needed varies depending on a person's age, gender, and other factors. According to the National Institutes of Health(NIH) women 19-69 need 600 IU and women age 70 and over need 800 IU of vitamin D per day.

Osteoporosis Canada recommends higher amounts at 800-2000 IU daily for women over 50.

Some top food sources of vitamin D include:

• Fatty fish like salmon, mackerel, and sardines
• Egg yolks
• Fortified foods such as dairy products, plant-based milks, cereals, and orange juice
• Mushrooms exposed to sunlight (like UV-treated varieties)

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.

For this reason I do usually recommend a daily supplement in addition to eating vitamin D-rich foods.

3.Vitamin K

Like vitamin D, vitamin K is produced in the body. It is essential for blood clotting and regulating bone metabolism.

Vitamin K deficiency is pretty rare as billions of bacteria in our gut make this vitamin. But it is still important to make sure we have a good amount in our diets.

The recommended daily intake for women 19 years or older is 90 micrograms/day.

Foods high in vitamin K:

1. Leafy green vegetables: Dark, leafy greens are the best source of vitamin K. Some examples include kale, spinach, collard greens, and Swiss chard.
2. Broccoli: Broccoli is a good source of vitamin K. It also contains calcium and vitamin C, which are important for maintaining healthy bones.
3. Brussels sprouts: Brussels sprouts are a good source of vitamin K, as well as vitamins C and A.
4. Cabbage: Along with vitamin K, cabbage has other essential nutrients like vitamin C and fiber.
5. Soybeans/edamame: Soybeans are also a good source of plant-based protein and fibre.
6. Kiwi Fruit: Kiwi Fruit are a good source of vitamin K, as well as fiber, potassium, and vitamin A.
7. Natto: Natto is a traditional Japanese dish made from fermented soybeans. It is a rich source of vitamin K, as well as protein, fibre and potassium.

The effects of vitamin K on bone density in healthy women going through the menopausal transition isn’t clear.

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.

At this point, it is safe to say you want to make sure you are eating your greens.

4. Protein

The relationship between dietary protein intake and bone health has been a topic of debate for decades.

Protein is essential not just for muscle maintenance but for building and preserving bone as well. However, exactly how much protein—and what kind—is most beneficial remains an area of active research.

Increased protein intake (at or above 0.8 g/kg of body weight per day) has been associated with greater bone density, a slower rate of bone loss, and a reduced risk of hip fractures.

Some experts recommend even higher intakes—around 1.3 to 1.6 g/kg/day—to support muscle mass and strength, both of which have a positive impact on bone mass.

That said, there’s concern that very high protein intakes (above 1.5 g/kg/day) may increase calcium excretion through urine, potentially disrupting calcium balance.

I typically advise starting with 1.0–1.2 grams of protein per kg of body weight per day. Or 1.3-1.5 grams per kg if consistently weight training.

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.

These foods contain isoflavones, plant compounds shown to stimulate bone formation and reduce bone loss during 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—think 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.

According to Dr. Jen Gunter, older women who smoke lose an additional 2% of bone density for every 10 years after menopause. Quitting can slow this loss and offer benefits beyond just your bones.

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. The evidence here is mixed, but there’s some indication that 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.

Most experts suggest limiting yourself 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.