Turning 45? Bone health questions women ask

This page is for women in their 40s. Many women start to ask about their bones at this age, when periods begin to change and menopause comes closer. This page answers the questions women commonly ask, and most of it is about the bone loss of menopause. It uses published studies and guidelines, and it says where a number comes from a study outside India.

When do women lose bone fastest?

Women lose bone fastest in the years around the last period. Bone loss starts about 1 year before the last period. It slows about 2 years after it, but it does not stop.

A large study in the US followed women for 10 years. Over that time they lost about a tenth of their spine bone, 10.6%. About two-thirds of that loss happened in the 3 years around the last period. No similar study has been done in India.

Is it different for Indian women?

Indian women reach menopause earlier, at about 46.6 years on average. Hip fractures, or broken hips, happen about 10 years earlier in India than in Western countries. Many Indian women get less calcium than they need, and many have low vitamin D.

When should I start thinking about my bones?

The Indian Menopause Society suggests learning about bone health from age 35. It suggests checks for low bone mass from age 40. This advice comes from expert opinion, not from trials.

My periods are irregular. Do I need a bone scan?

Not for that reason alone. Doctors in India, the UK and the US decide on a bone scan based on your risk of weak bones, not on your periods. Our guide DEXA scan explained lists who usually needs one.

What raises my risk of weak bones?

These things raise the risk of osteoporosis, which means weak, thin bones:

• a broken bone after a small fall
• taking steroid tablets, called glucocorticoids, for a long time
• menopause at or before 45
• low body weight
• a parent who broke a hip
• smoking
• heavy drinking
• rheumatoid arthritis
• some epilepsy medicines

Having one of these does not mean you will break a bone. It means your risk is higher, and your doctor may want to look at your bone health.

What can I do now?

These steps are worth discussing with your doctor:

• Get calcium from food.
• Have low vitamin D corrected.
• Do strength and balance exercise.
• Stop smoking and keep alcohol low.

These steps help bone density, which means how much mineral your bones hold. They also help your muscles. Trials have not shown that these steps alone prevent fractures. Our guide Exercise and food for stronger bones has more detail.

Does hormone therapy help my bones?

Hormone therapy, often called HRT, stops the bone loss of menopause while you take it. The benefit fades after you stop. Doctors disagree about using HRT only to protect bones. Our guide Is HRT safe for my bones sets out the benefits and the risks.

For doctors

The evidence behind this page is in Bone health in perimenopause, Osteoporosis questions and evidence answers and HRT and bone.

Talking to a doctor in Patiala

To talk about your bone health with Dr Aditya Aggarwal, orthopaedic surgeon, call Aggarwal Clinic on +91 98768 24676.

Aggarwal Clinic, 1-E, The Mall, Patiala.

This page is general information, not medical advice. Please talk to your doctor about what is right for you.