A two-part guide: first, why bone health changes around the menopause; and second, how hormone treatments (HRT) can help to improve it. It also explains key terms in plain English and suggests questions you might ask your doctor or healthcare professional.
Bone is alive and constantly renewed. The body continuously removes old bone and lays down new bone to replace it, and your hormones — progesterone, estradiol and testosterone — work to keep that renewal in balance, acting as a brake on the cells that break bone down.
As the ovaries wind down, hormone levels fall and the brake comes off. Bone is then removed faster than it is replaced. Loss is fastest in a narrow window — from about a year before periods stop to a year or two after — and women can lose up to about a tenth of the bone in the spine and hip over the decade around menopause.
Bone keeps thinning, but more slowly. Hormone levels stay low; very low levels are linked to a greater chance of fracture at the hip and spine.
Around menopause, bone health changes mainly because of falling hormone levels. Bone thins fastest around the time periods stop, then more slowly afterwards.
Yes — and this is backed by strong evidence. Large, carefully designed trials show that replacing hormones slows bone loss and reduces the chance of breaking a bone at the hip and spine by roughly a quarter to a third, by restoring this brake on bone breakdown.
Timing matters: hormone treatments help bone most when started early. The benefit is greatest around the menopause or within about ten years of it — the “window of opportunity”. It is not permanent, though: once hormone treatments are stopped, in the first year or so there is a slight increase in risk of fracturing, but this disappears — and even though the bone gradually begins to thin again, the risk of fracture is often less than in women who have never taken any hormone treatments.
It is your decision about taking hormone treatments. Hormone treatments mainly prevent bone loss rather than treating established osteoporosis. There are other benefits too: the right dose and type of hormone treatment will improve symptoms and may also reduce the future risk of other conditions, including heart disease, type 2 diabetes, some cancers, auto-immune diseases, and dementia and other neurodegenerative diseases.
Hormone treatments are the most effective way to replace bone-protecting hormones and lower the chance of fractures — most of all when started early. The benefit reduces if you stop them.
About this guide: it is based on large, long-term studies and randomised trials — the strongest kinds of medical evidence — and on current menopause guidance. It gives general information only and is not a substitute for personal medical advice. Hormone therapy has both benefits and risks; please discuss your own situation with your GP or a healthcare professional. · June 2026
2nd February 2026 @ 20:00 GMT
Nutrition and musculoskeletal health
Given by: Dr Kimberley Zambito, Orthopaedic Consultant
Hosted by: Dr Nick Birch
Throughout 2026 and beyond, IIMHE (the International Institute of Musculoskeletal Health Education), in partnership with OsteoscanUK, will host a series of engaging educational webinars, open to anyone interested in bone and musculoskeletal health.
