For many women, menopause is framed as a period defined by hot flashes, night sweats, and changes in mood or sleep. While these symptoms can certainly affect quality of life, they are only part of a much larger physiological transition. One of the most significant—and often underappreciated—health concerns associated with menopause is its impact on bone health. Osteoporosis, along with its precursor states and related muscle loss, represents a serious but largely preventable threat to long-term independence and healthy aging.
Dr. Steven R. Goldstein is a Menopause Specialist NYC. He is a Certified Menopause Practitioner and a past President of both The Menopause Society and the International Menopause Society. He is also a former Co Directory of Bone Densitometry and Body Composition at NYU Langone Medical Center.
Dr Goldstein has spent decades caring for women in perimenopause and menopause, with a particular focus on the profound relationship between hormonal changes and skeletal health. His work emphasizes that bone health is not a niche concern, but a central pillar of longevity, mobility, and overall wellbeing.
Understanding Bone Health in Menopause
Bone is not a static structure. Throughout life, it is continuously remodeled through a balance of bone formation and bone resorption. In healthy younger women, these processes are tightly regulated and generally remain in equilibrium. In women, Estrogen plays a crucial role in this balance by slowing the breakdown of bone.
During menopause, ovarian production of estrogen declines sharply. Without estrogen’s protective effect, bone resorption accelerates, tipping the balance toward bone loss. This process can occur rapidly, particularly in the first several years after menopause, placing women at increased risk for weakened bones and fractures.
Because women today are living longer than ever before, the consequences of postmenopausal bone loss extend over decades. Many women will spend 40 percent or more of their lives in a low-estrogen state. This makes early awareness and proactive management of bone health essential, rather than optional.
Osteopenia and Osteoporosis: What’s the Difference?
Bone loss exists along a spectrum. Osteopenia is often described as a midpoint between normal bone density and osteoporosis. While the term is commonly used, it can be misleading when considered in isolation. Two women labeled with osteopenia may have very different fracture risks depending on their actual bone density measurements, rate of bone loss, age, and overall health.
Osteoporosis represents more advanced bone thinning and structural weakness. At this stage, bones are fragile and prone to fractures, even from minor falls or everyday activities. Fractures of the hip, spine, and wrist are especially common and can be life-altering.
Dr. Goldstein, a Menopause Specialist NYC, emphasizes individualized assessment rather than relying on labels alone. Bone density testing, typically performed with a DEXA scan, provides objective data that can guide meaningful discussions about risk and treatment options.
Why Bone Health Matters More Than Ever
The medical consequences of osteoporosis extend far beyond broken bones. A hip fracture, for example, is not simply an orthopedic injury. It is a major health event that can permanently alter a woman’s independence and survival. A significant proportion of women who suffer hip fractures are unable to return to independent living, and mortality rates in the year following a fracture remain alarmingly high.
As life expectancy increases, the goal is not merely to live longer, but to live well. Strong bones are fundamental to maintaining mobility, balance, and confidence. Preventing bone loss is therefore an essential component of healthy aging, on par with cardiovascular health or cancer prevention.
The Overlooked Role of Muscle: Sarcopenia
Bone health does not exist in isolation. Muscle mass and strength play a critical supporting role in protecting the skeleton. Sarcopenia, the age-related loss of muscle mass and function, often progresses quietly alongside bone loss.
When low bone density and muscle weakness occur together, the risk of falls and fractures increases dramatically. This combination has a compounding effect, making prevention strategies even more important.
Regular physical activity, particularly strength training and balance exercises, can help preserve muscle mass and coordination. Maintaining muscle strength supports posture, stability, and reaction time, all of which reduce the likelihood of falls. Dr. Goldstein, an Osteoporosis Specialist NYC, encourages his patients to aim not merely for average fitness, but to remain as strong and capable as possible as they age.
Risk Factors for Osteoporosis
While menopause is a major driver of bone loss, several additional factors influence a woman’s risk of developing osteoporosis:
• Gender: Women are more vulnerable to
osteoporosis due to smaller bone size and hormonal changes associated with
menopause.
• Age: Bone density naturally declines with age, and the rate of loss can
accelerate after menopause.
• Lifestyle factors: Inadequate nutrition, limited physical activity, smoking,
and excessive alcohol use can all contribute to weaker bones.
• Medical conditions and medications: Certain health conditions and long-term
use of specific medications can adversely affect bone density.
Understanding these risk factors allows for earlier screening and targeted prevention strategies.
Silent Progression and the Importance of Screening
One of the most challenging aspects of osteoporosis is that it often progresses without noticeable symptoms. Many women are unaware they have low bone density until a fracture occurs. By that point, significant bone loss may have already taken place.
As osteoporosis advances, signs may include back pain, loss of height, stooped posture, or fractures occurring with minimal trauma. However, relying on symptoms alone is insufficient. Proactive screening during perimenopause and menopause is essential to identify bone loss early, when interventions are most effective.
A Comprehensive Approach to Bone Health
Protecting bone health during and after menopause requires a multifaceted approach. This includes appropriate screening, lifestyle modifications, and individualized medical management when necessary.
Nutrition plays a foundational role. Adequate intake of calcium, vitamin D, and other nutrients supports bone remodeling. Physical activity, particularly weight-bearing and resistance exercises, strengthens both bones and muscles. Avoiding smoking and limiting alcohol further reduces risk.
For some women, lifestyle measures alone may not be sufficient. In these cases, medical therapies can help slow bone loss or improve bone density. Decisions regarding treatment should be made in consultation with an experienced clinician who understands the complex interplay between hormones, bone biology, and individual risk factors.
Partnering for Long-Term Bone Health
Menopause represents a critical window of opportunity to protect skeletal health for decades to come. With proper evaluation and personalized care, many women can significantly reduce their risk of osteoporosis-related fractures.
Dr. Steven R. Goldstein’s long-standing focus on bone health reflects his commitment to helping women age with strength, independence, and confidence. Through education, screening, and individualized guidance, women can take meaningful steps to preserve their bones and their quality of life well beyond menopause.
Bone health is not just about preventing fractures—it is about preserving freedom, mobility, and the ability to fully engage in life at every stage.
If you are Menopausal, approaching menopause or postmenopausal and are concerned about your bone health, then a consultation with Dr Steven R. Goldstein, a Menopause, Osteoporosis and Perimenopause Specialist NYC may be in order.
