After menopause, bone loss speeds up because oestrogen falls away. In the first five to seven years you can lose up to around 20% of your bone density (Santoro, 2016). It happens gradually and without complaints, so many women only notice it when a bone breaks. A few blood values and your risk profile together give a first direction.
This is the overview article in our postmenopause series. I notice that bone health often only comes up after something goes wrong, while the years around menopause are exactly when you can do the most about it. Below you will read why bone loss speeds up after menopause, which risk factors matter, which values give insight and what you can do yourself.
Why does bone loss speed up after menopause?
Bone loss speeds up after menopause mainly because oestrogen drops sharply. Oestrogen helps keep your bones up to strength by slowing bone breakdown. When that brake falls away, breakdown runs faster than build-up, and your bone density falls.
Your bone is not dead material, it is alive. It is constantly broken down and rebuilt, throughout your whole life.
Before menopause, breakdown and build-up stay reasonably balanced. After menopause that balance shifts, and net bone loss can continue at a faster pace for a number of years. After that it usually levels off again.
What exactly is osteoporosis?
Osteoporosis, or bone loss, means your bones become more porous and weaker, so they break more easily. It is not an illness with direct complaints, but a creeping process. It often only comes to light through a fracture after a small fall.
There is an in-between step called osteopenia, a milder decline in bone density. Not everyone with osteopenia develops osteoporosis, but it can be an early signal.
Osteoporosis is not diagnosed with a blood test, but with a bone density scan (a DEXA scan) through your GP or a specialist. Blood values say something about your risk and about factors that influence bone, not about bone density itself.
Which risk factors matter?
The risk of bone loss depends on more than menopause alone. Some factors are fixed, such as your age and heredity. Others you can partly influence, such as exercise, nutrition and smoking.
Factors that can raise the risk:
- An early menopause (before 45), so oestrogen falls away sooner
- A fracture in a parent or sister, or osteoporosis in the family
- A low body weight or a slight build
- Smoking and heavy alcohol use
- Little exercise, especially little loading of the bones
- Long-term use of certain medicines, such as corticosteroids
If you recognise several of these points, it is useful to discuss your risk with your GP. The GP can judge whether a bone density scan is needed. The NHG guideline on fracture prevention (Fractuurpreventie) describes how doctors weigh that risk in the Netherlands.
Which blood values give insight?
A blood test does not establish osteoporosis, but it does show whether the building blocks for your bone are in order. Vitamin D and calcium play a part in particular. A shortage can encourage bone breakdown.
| Value | What it shows | Why it matters |
|---|---|---|
| Vitamin D (25-OH) | Your vitamin D store | Vitamin D helps absorb calcium from food |
| Calcium | The calcium level in your blood | Calcium is an important building block of bone |
A low vitamin D is common in the Netherlands, certainly in winter. Because vitamin D is needed to absorb calcium well, a shortage can indirectly burden the bone. The Gezondheidsraad therefore advises women from age 50 to take extra vitamin D daily.
Want these values measured? The Menopause test looks at the hormones and values that play a part around menopause, among others. You then discuss an abnormal result with your GP.
What can you do yourself for your bones?
Bone loss partly belongs to menopause, but you have influence over a good share of your risk. Exercise and nutrition are the first steps. They do not replace treatment, but they do support your bones.
What guidelines suggest can help:
- Regular weight-bearing exercise, such as walking, climbing stairs or strength training
- Getting enough calcium through food, for example dairy or fortified alternatives
- Extra vitamin D, certainly from age 50 and in winter, following Gezondheidsraad advice
- Stopping smoking and being moderate with alcohol
Good nutrition and exercise lower your risk, but give no guarantee. With a raised risk or after a fracture, medication may be needed. What suits you is something you decide together with your GP.
Want the wider picture of what changes after menopause first? Then read our article on what happens after menopause. Alongside your bones, your cardiovascular risk also changes, which you can read about in our article on cholesterol and heart health after menopause.
Testing your bones through Lunara: how it works
You do not need a GP referral for these blood values. You order online, book a slot at a draw location near you and have blood taken in the morning. You receive your result digitally, usually within a few working days.
Every result gets context from a BIG-registered doctor, per value. So you know not only what your vitamin D or calcium is, but what it can mean in your situation. For bone density itself, a DEXA scan through your GP or a specialist remains needed.
Frequently asked questions
Can you establish bone loss with a blood test?
No. Osteoporosis is established with a bone density scan (DEXA scan), not with blood. A blood test does show whether building blocks like vitamin D and calcium are in order, which says something about your risk.
How much bone density do you lose after menopause?
That differs per person. In the first years after menopause the loss can rise to around 20% (Santoro, 2016). After that it usually levels off. Your risk depends on more factors than menopause alone.
When is a bone density scan useful?
That depends on your risk profile. If you have several risk factors or an earlier fracture, your GP may consider a scan. The NHG guideline on fracture prevention (Fractuurpreventie) helps doctors make that judgement.
References
- Santoro N. Perimenopause: From Research to Practice. J Womens Health (Larchmt). 2016;25(4):332-339.
- NHG Guideline Fracture Prevention (Fractuurpreventie). Dutch College of General Practitioners. Available via nhg.org.
- Gezondheidsraad (Health Council of the Netherlands). Evaluation of the dietary reference values for vitamin D. The Hague.
- Thuisarts.nl. I want to prevent bone loss (osteoporosis). Available via thuisarts.nl.
Every blood test result through Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
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