Osteoporosis is often thought of as a problem of older age. But by the time many women begin thinking seriously about their bones, much of the story has already been written.
Bone is living tissue. Throughout life, it is continuously broken down and rebuilt. The balance between those processes changes with age, hormones, nutrition, physical activity, medical conditions and certain medications. What happens after menopause matters, but so do the years before it.
Bone health does not suddenly become important at menopause. During adolescence, the body is building bone. Through adulthood, the task is largely to maintain it. Later, particularly around and after menopause, bone loss and fracture risk may require closer attention.
Building Bone: Childhood, Adolescence and Early Adulthood
Childhood and adolescence are major periods of bone growth. During puberty, bone is being added rapidly while the body is also undergoing substantial hormonal and physical change.
Adequate nutrition and regular physical activity help support this process. Running, jumping, dancing, sports and resistance exercises can all provide mechanical stimulus to bone.
Menstrual health matters too. Very infrequent or absent periods can sometimes signal low estrogen exposure or another underlying problem that may affect bone development. Low energy intake, excessive exercise, eating disorders and some endocrine conditions can all require attention.
In athletes and highly active young women, prolonged low energy availability can occur when energy intake does not adequately meet the demands of training and normal physiological function. This is part of the recognised framework of Relative Energy Deficiency in Sport, or RED-S, which can affect menstrual function and bone health.
Persistent menstrual irregularity should not automatically be dismissed as a consequence of being athletic. Recurrent stress fractures, prolonged absence of periods or signs of inadequate nutrition deserve medical assessment.
Maintaining Bone Through Adulthood
By early adulthood, most women have reached or are approaching their peak bone mass. The question gradually changes from building as much bone as possible to maintaining what has been built.
This does not require a complicated “bone-health routine.” It means maintaining the conditions that support bone and recognising problems that may accelerate bone loss.
Regular weight-bearing activity and resistance training are useful not only for bone but also for muscle strength. Adequate nutrition matters across adulthood, particularly when restrictive eating, significant weight loss, menstrual disruption or chronic illness are present.
Smoking and heavy alcohol use can also increase the risk of poor bone health and fractures.[1]
Calcium, Vitamin D and the Rest of the Diet
Calcium and vitamin D receive much of the attention in conversations about bone health, but bone is not maintained by one nutrient or one supplement.
Calcium is an important structural component of bone, while vitamin D helps the body absorb calcium. Protein contributes to the framework of bone, and magnesium also plays a role in bone mineralisation.
For most women, food should be the starting point. An Indian diet can provide calcium through foods such as milk, curd, paneer, ragi, sesame, soy products and other calcium-containing foods. Protein can come from foods such as dal, pulses, dairy, soy, nuts and seeds.
How Much Calcium and Vitamin D Do You Need?
The reference amounts below are useful benchmarks for total daily intake. They are not instructions to take the same amount as a supplement.
Adolescents, 14–18 years
Calcium: 1,300 mg/day
Vitamin D: 600 IU/day
Women, 19–50 years
Calcium: 1,000 mg/day
Vitamin D: 600 IU/day
Women, 51–70 years
Calcium: 1,200 mg/day
Vitamin D: 600 IU/day
Adults, 71 years and older
Calcium: 1,200 mg/day
Vitamin D: 800 IU/day
Pregnancy and breastfeeding, 14–18 years
Calcium: 1,300 mg/day
Vitamin D: 600 IU/day
Pregnancy and breastfeeding, 19–50 years
Calcium: 1,000 mg/day
Vitamin D: 600 IU/day
These are general reference amounts. Individual needs may differ in the presence of documented deficiency, malabsorption, osteoporosis or other medical conditions.[2][3]
Supplements are not automatically necessary for everyone, and a dietary requirement is not the same thing as a prescribed supplement dose. Very high doses should not be assumed to provide greater benefit.
Pregnancy and Breastfeeding
Pregnancy and breastfeeding place additional demands on calcium metabolism and bone turnover. During breastfeeding, some calcium is temporarily mobilised from the mother's skeleton to support milk production.
For most healthy women, this loss is temporary and bone mass generally recovers after weaning and the return of menstruation.[4]
This is different from pregnancy- and lactation-associated osteoporosis (PLO), an uncommon condition that can be severe and is frequently under-recognised. It may present with multiple vertebral fractures, usually in late pregnancy or the early postpartum period.
Severe or persistent back pain, unexplained loss of height or a newly developing stooped posture can be warning signs of vertebral fracture rather than normal consequences of pregnancy or breastfeeding.[5]
Perimenopause and Menopause: When Bone Loss Can Accelerate
Estrogen helps maintain bone. During the menopausal transition, estrogen levels become increasingly variable and eventually decline. Around and after menopause, bone breakdown can temporarily outpace bone formation, leading to more rapid bone loss.[1] ACOG notes that this faster loss is particularly prominent during the first several years after menopause.[1]
This does not mean that every woman will develop osteoporosis. The effect of menopause depends partly on the amount of bone built earlier in life and on other factors that influence bone loss and fracture risk.
Early or premature menopause deserves particular attention because lower estrogen exposure begins sooner. Bone health is one of several long-term considerations when menopause occurs earlier than expected.[6]
The years around menopause are therefore an important time to consider bone health—not because every woman needs a scan or medication, but because risk factors can become more relevant.
Bone Health in India
Bone health in India needs to be considered in local nutritional and clinical contexts.
Vitamin D inadequacy has been widely reported across Indian populations, but estimates vary substantially because studies differ in geography, population, season and the thresholds used to define deficiency or insufficiency. A single dramatic percentage therefore does not apply equally to all Indian women.
This is one reason a risk-based approach is more useful than assuming that every woman has the same level of risk. Age, menopausal status, diet, physical activity, medical conditions, medications and fracture history all matter when deciding whether bone health needs closer assessment.
The Indian Menopause Society's 2026 clinical practice guidelines include bone health and osteoporosis within a broader framework for assessing health during and after the menopausal transition.[9]
For an individual reader, the more useful question is whether their own age, reproductive history, nutrition, medications, medical conditions and fracture history give them a reason to assess bone health more closely.
Understanding Bone Density: T-Scores, Z-Scores and Osteoporosis
Bone loss, low bone density and osteoporosis are related, but they are not the same thing.
Bone loss describes a process: bone is being lost over time.
Low bone density describes a measurement. It does not, by itself, explain why bone density is low or determine the likelihood of a fracture.
Osteoporosis describes substantially reduced bone strength and an increased risk of fracture.
Understanding a T-Score
The following categories are used primarily when interpreting DXA results in postmenopausal women and other clinical groups for whom T-score interpretation is appropriate. They should not be applied automatically to younger premenopausal women.
- −1.0 and above: normal bone density
- Below −1.0 to above −2.5: low bone mass, sometimes described as osteopenia
- −2.5 or below: meets the bone-density criterion for osteoporosis
A T-score is one part of the clinical picture. A previous fragility fracture and other risk factors can materially affect a person's fracture risk and management.[1][7]
Why Younger Women Are Interpreted Differently
For women before menopause, clinicians generally use a Z-score, which compares bone density with that of people of a similar age.
A Z-score of −2.0 or lower is described as “below the expected range for age.” Low bone density alone does not automatically establish osteoporosis in a younger woman. The result needs to be considered alongside fracture history and possible underlying causes.[7]
The same DXA number can therefore mean different things at different stages of life.
When Bone Health Needs Closer Assessment
Low bone density and osteoporosis can sometimes develop as part of another medical problem. This is often described as secondary osteoporosis.
Possible contributors include prolonged glucocorticoid use, endocrine disorders, conditions that impair nutrient absorption, prolonged states of low estrogen and certain chronic illnesses or medications.[1][7]
You may need earlier assessment if you have:
- Had a fracture after relatively minor trauma.
- Experienced unexplained loss of height or a newly developing stooped posture.
- Entered menopause early.
- Experienced prolonged absence of periods for an unexplained reason.
- Used medications associated with bone loss, particularly long-term glucocorticoids.
- Developed a medical condition known to affect bone strength.
A family history of hip fracture can also contribute to the overall risk picture.[1][7]
Where FRAX Fits In
Clinicians may use FRAX—the Fracture Risk Assessment Tool—to estimate a person's probability of having a major osteoporotic fracture over the next 10 years.
It combines factors such as age, body size, previous fractures, smoking, alcohol use, certain medical conditions and, where available, bone-density information. Risk assessment can help guide decisions about earlier testing and treatment.[1]
When Is a DXA Scan Useful?
A DXA scan measures bone mineral density. It is most useful when the result is likely to change what happens next.
Routine bone-density screening is recommended for women aged 65 and older. Earlier testing may be appropriate when fracture risk is higher because of a fragility fracture, medical conditions, medications or other significant risk factors.[1]
A healthy young woman does not usually need a DXA scan simply to find out whether her bones are “strong.”
The purpose of testing is to answer a clinical question—not to collect a number without knowing what it means.
Protecting Bone and Reducing Fracture Risk
Bone health is not protected by one supplement or one type of exercise.
Weight-bearing activity places force through the skeleton. Depending on your age, fitness and health, this may include brisk walking, stair climbing, jogging or other impact activity.
Resistance and strength training challenge muscles, which in turn place mechanical load on bone and help maintain muscle strength.
Falls Matter Too
Later in life, fracture risk depends not only on bone strength but also on the likelihood of falling.
Reducing fall risk may involve maintaining strength and balance, addressing vision problems, reviewing medicines that cause dizziness or sedation, improving lighting and reducing hazards at home, and using appropriate footwear or mobility support where needed.[1]
Someone with established osteoporosis, vertebral fractures or a high fracture risk may need an exercise plan adapted to reduce the risk of injury.
When Medication May Be Needed
Not everyone with low bone density needs medication, and not everyone with osteoporosis needs the same treatment.
Bisphosphonates reduce bone breakdown and are among the most commonly used osteoporosis medicines. Denosumab also reduces bone resorption but works differently. It should not usually be stopped or delayed without a follow-up treatment plan, because bone loss and fracture risk can increase after discontinuation.[8]
For people at very high fracture risk, bone-building medicines, often called anabolic agents, may be considered.[8]
Treatment decisions depend on factors such as previous fragility fractures, bone density, age, overall fracture risk and underlying causes of bone loss.
Menopausal hormone therapy can also help prevent bone loss and reduce fracture risk in appropriate candidates, particularly when treatment is being considered in the broader context of menopausal symptoms and other recognised indications. It is not automatically the right treatment for every woman with low bone density or osteoporosis.[6][8]
The aim of treatment is not simply to improve a scan result. It is to reduce the likelihood of fractures and protect long-term function.
The Long View
Bone health changes over decades.
You build much of your bone early in life. Through adulthood, the goal is largely to maintain it. Around menopause and later life, the focus may shift towards identifying accelerated loss, reducing fracture risk and treating osteoporosis when necessary.
The useful question is not whether you should worry about osteoporosis today. It is whether anything in your health, life stage or medical history gives you a reason to protect your bones more deliberately or assess them more closely.
References
[1] American College of Obstetricians and Gynecologists. Osteoporosis Prevention, Screening, and Diagnosis. ACOG Clinical Practice Guideline No. 1. Obstet Gynecol. 2021;138(3):494–506. doi:10.1097/AOG.0000000000004514.
[2] National Institutes of Health, Office of Dietary Supplements. Calcium: Fact Sheet for Consumers. Accessed August 25, 2026.
[3] National Institutes of Health, Office of Dietary Supplements. Vitamin D: Fact Sheet for Consumers. Accessed August 25, 2026.
[4] Grizzo FMF, Alarcão ACJ, Dell'Agnolo CM, et al. How does women's bone health recover after lactation? A systematic review and meta-analysis. Osteoporos Int. 2020;31(3):413–427. doi:10.1007/s00198-019-05236-8.
[5] Hadji P, Athanasiadis A, Brandi ML, et al. Pregnancy- and lactation-associated osteoporosis: A position statement of the IAPM, IOF, ECTS, ESCEO, IMS, and EMAS. Int J Gynaecol Obstet. 2026. doi:10.1002/ijgo.71203.
[6] American College of Obstetricians and Gynecologists. The Menopause Years. Women's Health FAQ. Published December 2018; last reviewed December 2025. Accessed August 25, 2026.
[7] International Society for Clinical Densitometry. 2023 ISCD Official Positions. 2023. Accessed August 25, 2026.
[8] American College of Obstetricians and Gynecologists. Management of Postmenopausal Osteoporosis. ACOG Clinical Practice Guideline No. 2. Obstet Gynecol. 2022;139(4):698–717.
[9] Meeta M, Anuradha M, Ashraf AB, Aggarwal K, Digumarti L, Singh T. Clinical Practice Guidelines for Menopause: An Executive Summary and Recommendations: Indian Menopause Society 2026. J Midlife Health. 2026;17(Suppl 1):S12–S116. doi:10.4103/jmh.jmh_302_25.