Bone health in menopause is one of the most important topics most women have never been properly told about. By the time osteoporosis is diagnosed, bone loss has often been happening silently for years, with no pain and no warning signs until a fracture.

The good news: osteoporosis is not an inevitable part of ageing. What you do in your 40s and 50s has a profound effect on the strength of your bones at 70, 80 and beyond. This guide covers why bone loss speeds up in menopause, the exercise that actually protects your bones, the nutrition they need, and a simple plan to start this week.

What happens to your bones in menopause

Bone is living tissue. It’s constantly broken down and rebuilt in a process called remodelling. Oestrogen acts as a brake on the breakdown side. When oestrogen falls through perimenopause and menopause, that brake is released and bone loss speeds up, especially in the spine, hips and wrists.

Women can lose up to 20% of their bone density in the five to seven years after menopause, and around one in two women over 50 will break a bone because of osteoporosis. Hip fractures in particular can be life-changing, with real risks to long-term mobility and independence.

Other things that affect bone health include low muscle mass, low activity, low protein, smoking, heavy drinking, and poor sleep and high stress.

The muscle and bone connection

When a muscle contracts against resistance, it pulls on the bone it’s attached to. That mechanical stress is the signal your body needs to maintain and rebuild bone. Without it, bones lose their reason to stay strong.

The problem is that falling oestrogen also speeds up muscle loss (sarcopenia). Less muscle means less pull on bone, which means more bone loss. Left alone, the two feed each other. Breaking that cycle takes the right exercise and the right nutrition, working together.

The best exercise for osteoporosis prevention

Not all exercise is equal for bones. Walking is wonderful for general health, but on its own it isn’t enough. The Royal Osteoporosis Society recommends a combination of three things:

1. Strength training

Resistance training is one of the most effective ways to maintain bone density, because it loads the spine, hips and wrists directly, the sites most at risk of fracture. Squats, deadlifts, lunges, step-ups, rows, presses and carrying weights all count. Aim for two to three sessions a week, and gradually increase the challenge over time (progressive overload). “Heavy” means heavy relative to you, not bodybuilding. New to it? Start with my guide to strength training in menopause.

2. Impact and weight-bearing exercise

Bones respond to the jolt of impact. That doesn’t mean extreme workouts. Small jumps, hops, skipping, heel drops, jogging, stair climbing, dancing and brisk or hill walking all create forces that tell bone to stay strong. Brisk daily walks are a great base, especially combined with strength work.

3. Balance and power

Most hip fractures happen because of a fall, not a spontaneous break. Single-leg stands, walking lunges, tai chi and work on uneven surfaces all improve balance. So does training the speed of your movements, because quick reactions are what stop a stumble becoming a fall. Read more in power vs strength after 40.

If you’re new to exercise or returning after a break, start gently and build up. If you already have osteoporosis, joint pain or have had a fracture, talk to your GP or physio about which impact and lifting exercises are right for you. The Royal Osteoporosis Society also has specific guidance.

The nutrition your bones need

• Calcium: the main mineral in bone. UK guidance is at least 700mg a day, ideally from food: dairy, fortified plant milks, kale and bok choy, tinned sardines with the bones, almonds and calcium-set tofu.
• Vitamin D: without it, you can’t absorb calcium properly. Many people in the UK are low, especially in winter, and the NHS advises everyone to consider a 10 microgram (400 IU) supplement in autumn and winter. If you think you may be low, ask your GP about a test.
• Protein: bone isn’t just mineral. It has a protein framework, mostly collagen, that helps it resist fracture. Around 1.2 to 1.6g of protein per kilogram of body weight a day supports both muscle and bone. See what to eat in menopause.

Where creatine fits in

Creatine monohydrate is one of the most researched supplements there is. Its clearest benefit is for muscle: combined with resistance training, it supports strength, training capacity and lean mass. More muscle and better training mean more pull on bone, so creatine can support your bones indirectly.

Whether creatine benefits bone directly is still an open question. Some trials in postmenopausal women found that creatine plus resistance training slowed bone loss at the hip, while a larger two-year trial found no difference in bone density. As a pharmacologist, my honest summary: promising, not proven, and never a substitute for training. I go into the detail in can creatine help bone health during menopause?

The typical dose is 3 to 5g a day, with no loading phase needed, and it’s considered safe for healthy adults. PausePower is the pure creatine monohydrate I take every day: no fillers, nothing unnecessary. For the full picture, read my guide to creatine for women in menopause.

Your bone health action plan

This week

1. Add a calcium-rich food to each main meal.
2. Start a vitamin D supplement for the autumn and winter months, or ask your GP about a test.
3. Go for a brisk walk most days.

This month

1. Start or restart strength training: two sessions a week is enough to begin.
2. Add some gentle impact: heel drops, small hops or stairs.
3. Bring your protein up towards 1.2 to 1.6g per kg of body weight.

Longer term

1. Build to three strength sessions a week.
2. Include balance and power work: single-leg exercises, uneven surfaces, faster sit-to-stands.
3. Ask your GP whether a DEXA scan to check your bone density is right for you.

Already diagnosed with osteopenia? Read can osteopenia be reversed?

The message I want you to take away

Your bones respond to everything you do: every weight you lift, every step you take, every meal you eat. Osteoporosis is largely preventable with the right exercise and nutrition, started at the right time. The right time is now, whatever your age and whatever your starting point.

Want support? I coach women 40+ through personalised strength, balance and nutrition plans, online anywhere in the world or in person in London. Get in touch for a free consultation.

Marleen Konijnenberg is a pharmacologist (BSc Pharmacology, King’s College London), certified personal trainer and menopause coach, and founder of FemVital.

General information, not medical advice. If you have osteoporosis, a previous fracture or any medical condition, check with your GP or a physiotherapist before starting impact or heavy strength exercise.

Key sources: Royal Osteoporosis Society guidance on exercise and bone health; International Osteoporosis Foundation exercise recommendations; NHS vitamin D advice; Chilibeck PD et al. and Candow DG et al. on creatine, resistance training and ageing musculoskeletal health; Forbes SC et al. (2021), creatine in women’s health; Guadalupe-Grau A et al. (2009), mechanical loading and bone.