What is osteoporosis?
Osteoporosis is a condition where your bones gradually become less dense and more fragile. It is common, it is largely silent, and it is something most women are not told enough about until well after the point where early action could have made a difference.
What happens to your bones
Bone is living tissue. Your body is constantly breaking down old bone and building new bone to replace it. Estrogen plays a key role in keeping that process balanced. As your estrogen falls during perimenopause and menopause, bone breakdown starts to outpace bone building, and density reduces over time.
Who is more likely to develop it
Any woman can develop osteoporosis, and the risk increases with age. The menopausal transition is the period when bone loss is fastest, which is why acting during perimenopause and early menopause matters.
Some factors increase the likelihood. A family history of osteoporosis, a slight or small frame, smoking, low calcium intake over many years, and limited physical activity throughout life all play a role. Previous fractures from minor incidents are also worth discussing with your doctor.
Osteopenia and osteoporosis: what is the difference?
Osteopenia and osteoporosis describe different points on the same spectrum. Both mean your bone density is lower than it should be, but osteoporosis is the more advanced stage.
Osteopenia means your bones are less dense than normal but not yet at the level where fracture risk is significantly raised. Think of it as a warning sign rather than a diagnosis requiring treatment. It is common in women after menopause and does not automatically progress to osteoporosis.
Osteoporosis means bone density has fallen further, to the point where bones become fragile and fracture risk increases significantly. A fracture from a minor fall or even everyday activity is possible at this stage.
The distinction matters because what you do at the osteopenia stage can make a real difference to whether things progress. Exercise, nutrition and in some cases medical treatment can all help.
What helps
There is a lot you can do, whether you are in perimenopause, menopause or postmenopause. It is never too late for exercise and good nutrition to make a difference to your bone health.
Exercise is one of the most important tools available. Resistance training and impact activity, things like brisk walking, jogging, jumping and weight bearing movement, help maintain and in some cases improve bone density.
Nutrition is also important, particularly calcium and vitamin D. If you live in southern Australia, including Tasmania, you may not be getting enough vitamin D from sunlight alone, particularly in winter. It is worth discussing this with your doctor.
In some cases medical treatment is also appropriate, and again your doctor is the right person to help you work out what is right for you.
Finding out where you stand
If you are concerned about your bone health, a bone density scan, called a DEXA scan, can give you a clear picture of where things are. Talk to your doctor about whether one is appropriate for you.
For more detail on what exercise helps most and how to approach it, see our article on exercise and bone health in perimenopause and menopause.
References
Howe, T.E., Shea, B., Dawson, L.J., Downie, F., Murray, A., Ross, C., Harbour, R.T., Caldwell, L.M., & Creed, G. (2011). Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews, 7, CD000333. https://doi.org/10.1002/14651858.CD000333.pub2
Nedergaard, A., Henriksen, K., Karsdal, M., & Christiansen, C. (2013). Menopause, estrogens and frailty. Gynecological Endocrinology, 29, 418-423. https://doi.org/10.3109/09513590.2012.754879
RACGP and Healthy Bones Australia. (2024). Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age. Royal Australian College of General Practitioners.
Watson, S.L., Weeks, B.K., Weis, L.J., Harding, A.T., Horan, S.A., & Beck, B.R. (2019). High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial. Journal of Bone and Mineral Research, 34(3), 475-485. https://doi.org/10.1002/jbmr.3659
Wright, V.J., Schwartzman, J.D., Itinoche, R., & Wittstein, J. (2024). The musculoskeletal syndrome of menopause. Climacteric, 27(5), 466-472. https://doi.org/10.1080/13697137.2024.2380363
Developed by the WHEN Clinical Team
Clinically reviewed by the WHEN Clinical Governance Committee
Last reviewed: July 2026
