Women can lose up to 20% of their bone density in the five to seven years after the menopause. The drop in bone density is caused by falling levels of the female hormone oestrogen. Oestrogen helps to protect bone strength. Although your bone density decreases at the menopause, your risk of osteoporosis (weak bones) and fractures (broken bones) stays relatively low until you get much older.

This is because bone density is only one of the things that affects your bone strength. However, the menopause is a good time to take stock and adopt a healthier, bone-friendly lifestyle.

Healthy bones after the menopause

While you can't halt bone loss entirely after the menopause, there is plenty you can do to maintain your bone strength as you get older.

Stay active

It's recommended that adults aged 19 to 64 do at least 150 minutes of moderate-intensity activity in bouts of 10 minutes or more each week. This could include activities such as cycling or brisk walking.

You should also try to avoid sitting for long periods, for example, watching TV or sitting at a computer. Weight-bearing exercises and resistance exercises are particularly important for improving bone strength and helping to prevent osteoporosis:

Weight-bearing exercises

These are exercises where your legs and feet support your weight. High impact weight-bearing exercises, such as running, skipping, dancing and aerobics are all great for strengthening muscles, bones and joints. These can be part of your weekly 150 minutes of moderate intensity activity.

Resistance exercises

These are ones where you use your muscle strength to work against resistance. When your muscles pull on your bones it boosts your bone strength. Examples include press-ups, exercising with weights or using weight equipment at a gym. Do resistance exercises twice a week if you can.

Eat a healthy, balanced diet

Eating a healthy, balanced diet will help keep your bones healthy after the menopause. For help with eating a balanced diet that includes all the main food groups, see the Eatwell Guide. A couple of nutrients are particularly important for building strong bones: calcium and vitamin D.

Calcium

Good sources include green, leafy vegetables (but not spinach), nuts, seeds, dried fruit, tinned fish with the bones in, and dairy products like milk, yoghurt and cheese. Lower-fat dairy products contain just as much calcium as full-fat ones.

Vitamin D

Good food sources include oily fish, eggs, and fat spreads or breakfast cereals fortified with vitamin D. It's difficult to get enough vitamin D from food alone, so all adults are advised to consider taking a daily vitamin D supplement, particularly in the winter months (October to March).  

Get some sunlight

Sunlight on your skin helps to build up your body's supply of vitamin D. Aim to spend short periods outdoors each day from late March/April to the end of September. Take care not to let your skin redden or burn.

Drink sensibly and don't smoke

Smoking is linked to a higher risk of osteoporosis and so is drinking too much alcohol. As well as protecting your bones, quitting smoking will help to lower your risk of heart disease, cancer and other smoking-related diseases. Men and women are advised not to regularly drink more than 14 units a week.

Will I need a drug treatment for my bones?

You'll usually only need treatment to strengthen your bones at the menopause if you have a higher risk of osteoporosis or fractures. Examples of things that can affect your fracture risk include:

• having rheumatoid arthritis
• taking glucocorticoids (steroids) for more than three months
• having already broken a bone (or bones) after a minor fall or injury

If you have risk factors for osteoporosis or fractures, talk to your doctor. You may need a bone check-up, known as a fracture risk assessment. This may include a bone density (DEXA or DXA) scan to help measure your bone strength (strength is about more than bone density).

Hormone replacement therapy (HRT) and bone health

HRT can help to maintain bone density and reduce the risk of osteoporosis. However, it's not recommended as a way to maintain bone strength for most women around the menopause.

One reason is that the beneficial effects of HRT on your bones wear off when you stop taking it (usually before the age of 60). So your bones won't have protection when you're older, which is when they really need it. HRT also carries some risks, including a slightly higher risk of stroke. This means it's not suitable as a bone treatment in older women, whose risk of stroke is already higher.

HRT may be recommended if:

• you have a premature menopause (when your periods stop before the age of 40), as you have a higher risk of osteoporosis
• you have an early menopause (when your periods stop before the age of 45) and you also have other risk factors for osteoporosis

HRT may be offered as an osteoporosis treatment to other menopausal women with a high risk of fracture. But it's usually only advised if other drug treatments for osteoporosis aren't suitable and you also need treatment to relieve menopausal symptoms like hot flushes.