Bone loss: the menopause change you cannot feel (until a small fall breaks a wrist)

Your bones are rebuilt all the time. Estrogen slows the part that breaks bone down. When estrogen falls in perimenopause and after menopause, breakdown outpaces rebuilding. The NHS says falling estrogen after menopause "can lead to a rapid decrease in bone density".

Over years this can lead to osteoporosis: bones that are thin and break easily, often at the wrist, spine or hip. Women who reach menopause early, including after surgical menopause, lose that protection sooner, so their risk is higher (see early menopause).

You cannot feel bone loss. Joint aches and back pain are common in midlife (see joint pain), but they are not a sign of thin bones by themselves. The only way to know your bone density is to measure it.

Menopause is the most common reason for faster bone loss in women over 45, but doctors also check for other causes and risk factors (most are on the NHS list of osteoporosis risks):

• Thyroid. An overactive thyroid, or too high a dose of thyroid medicine, speeds up bone loss. A TSH test is ₱490 per test (Exact Check).
• Medication. Long-term, high-dose steroid tablets (such as prednisone) are a well-known cause.
• Low vitamin D. A vitamin D test is ₱2,830 per test (Exact Check).
• Low body weight (a BMI of 19 or less), smoking, heavy drinking and a parent who broke a hip all add risk.
• Anemia, depression and other illnesses do not thin bones directly, but they can lower activity and appetite, which matters over time.

Prices checked October 2026.

A DXA scan is a quick, low-dose X-ray that measures bone density. Makati Medical Center's Center for Osteoporosis and Bone Health calls it the gold-standard test. St. Luke's suggests discussing it from age 50, or sooner if you break a bone in a minor fall.

Your result comes as a T-score. A T-score of -2.5 or lower means osteoporosis.

Sample PH prices:

• DXA, lumbar spine and hips: ₱2,400 per scan (Exact Check)
• DXA, forearm: ₱1,500 per scan (Exact Check)
• Healthway (estimate from a search listing, call to confirm): ₱4,500 to ₱6,100 per scan (promo to regular) (Healthway)

Prices checked October 2026. See our bone density test guide for more providers and who should get one.

HRT: Strong evidence. The Menopause Society (2022) says hormone therapy prevents osteoporotic fractures, and lists osteoporosis prevention as a reason some women continue HRT past 65. It is not usually started for bones alone, but if you have hot flashes too, it can help both. See HRT for menopause.

Bone medicines (bisphosphonates): Strong evidence. For women with osteoporosis or high fracture risk, doctors often prescribe bisphosphonates. The NHS says they slow bone breakdown, which keeps bone density up and lowers the risk of a broken bone. They usually take 6 to 12 months to work and are often taken for 5 years or longer. One PH option is alendronate with vitamin D3 (Fosavance), ₱1,190.75 per box of 2 tablets (2 weeks) (Watsons), Rx only.

Strength training and weight-bearing exercise: Some evidence. PGH doctors at the 2025 UP Manila symposium recommended strength training 2 to 3 times a week plus 150 minutes of activity a week. Walking, stairs, resistance bands and water-bottle weights all count. Balance work lowers the chance of falling.

Calcium and vitamin D: Some evidence. Food first: dilis, tuyo, sardinas, tokwa, malunggay and milk. Try our Filipino calcium calculator to see what you get from food. If you fall short, your doctor may suggest a supplement such as Caltrate Silver Advance Plus, ₱397.25 per bottle of 30 (Watsons). Supplements carry "No approved therapeutic claims" in the PH; see supplement ratings.

Non-hormonal hot flash medicines: Not enough evidence for bones. The options on our non-hormonal treatments page do not protect bone.

Prices checked October 2026. For full costs, see costs.

See a doctor soon if:

• You break a bone from a minor fall or bump.
• You lose height or your upper back starts to curve.
• You have sudden, severe back pain, especially after lifting or a fall.
• Your periods stopped before 45, or before 40.

Use the symptom checker to list your other symptoms, then find a doctor who can order a DXA scan.