As women transition through menopause, many become focused on symptoms such as hot flashes, sleep disturbances, mood changes, and weight gain. However, one of the most important long-term health concerns associated with menopause is often less visible: bone loss. Maintaining strong bones is essential for healthy aging, preserving independence, and reducing the risk of life-changing fractures later in life.
According to Dr. Steven R. Goldstein, a renowned Menopause Specialist NYC, President of the International Menopause Society, Certified Menopause Practitioner, and experienced clinician who has helped thousands of women navigate menopause, understanding how bone health changes after menopause is critical to protecting long-term wellness.
Why Menopause Accelerates Bone Loss
Bone is not a static structure. Throughout life, the body is constantly removing old bone and replacing it with new bone. This ongoing process, known as bone remodeling, helps maintain bone strength and integrity.
One of estrogen's important functions is to slow down the process of bone breakdown. During a woman's reproductive years, estrogen acts as a powerful protector of bone health by limiting the removal of bone tissue. However, when menopause occurs and estrogen production declines dramatically, this protection is lost.
As a result, many women begin to lose bone density at a much faster rate. Over time, this can lead to osteopenia, a condition characterized by lower-than-normal bone density, and eventually osteoporosis, a disease in which bones become fragile and more susceptible to fractures.
The years immediately following menopause are often when the most rapid bone loss occurs, making early monitoring and prevention especially important.
Understanding Osteoporosis
Osteoporosis is often called a "silent disease" because it develops gradually and usually causes no symptoms until a fracture occurs. Many women do not realize they have osteoporosis until they suffer a broken bone from what would otherwise be considered a minor fall or injury.
The most common osteoporosis-related fractures occur in the hip, spine, and wrist. Vertebral fractures, involving the bones of the spinal column, are particularly common and can lead to chronic pain, loss of height, and changes in posture.
Hip fractures are among the most serious complications of osteoporosis. As life expectancy continues to increase, maintaining bone strength becomes increasingly important. Women today routinely live into their 80s and 90s, making bone health a vital component of healthy aging.
The consequences of a hip fracture can be devastating. Research has shown that approximately 25% of women who suffer a hip fracture never regain the ability to live independently. Furthermore, between 20% and 30% may die within one year of the fracture due to complications related to surgery, immobility, infections, or other health issues.
For this reason, bone health deserves the same level of attention as cardiovascular health, cancer prevention, and maintaining cognitive function.
Traditional Treatments for Osteoporosis
Many of the medications commonly used to treat osteoporosis work by slowing the removal of bone. These medications are known as anti-resorptive therapies.
Anti-resorptive medications help restore balance to the bone remodeling process by reducing the amount of bone being broken down. Because less bone is removed, the body can maintain or gradually increase bone density over time.
These medications have helped millions of women reduce fracture risk and remain an important part of osteoporosis management.
There are also anabolic bone medications that actively stimulate the formation of new bone. Medications such as Forteo and Tymlos fall into this category. Unlike anti-resorptive therapies, these medications focus primarily on building new bone tissue.
Historically, anabolic therapies have generally been reserved for patients with severe osteoporosis because of treatment limitations and concerns that arose during animal studies. Their use is typically restricted to a limited duration of treatment.
A New Option: Evenity
One of the newer developments in osteoporosis treatment is a medication called Evenity. Evenity represents a different approach to treating osteoporosis. Rather than simply slowing bone breakdown or only stimulating bone formation, it works through a sophisticated biological mechanism involving genetically engineered antibodies.
The medication targets a protein that naturally limits bone formation. By blocking this protein, Evenity helps the body build new bone while also reducing bone breakdown. This dual action has generated significant interest among osteoporosis specialists because it addresses both sides of the bone remodeling equation.
In simple terms, Evenity helps restore bone while simultaneously reducing the loss of existing bone.
Why the Excitement About Evenity?
Evenity attracted widespread attention following the publication of major clinical trial results involving nearly 8,000 women. The results demonstrated significant improvements in bone density and reductions in fracture risk. For patients suffering from severe osteoporosis, these findings were encouraging and represented an important advancement in available treatment options.
However, it is important to understand who participated in these studies.
The women enrolled in the clinical trial were not typical patients with mild bone loss. Every participant had osteoporosis, and each had already suffered at least one vertebral fracture. In other words, these women were considered extremely high-risk patients with advanced disease.
This distinction is important because the benefits and risks of any medication must always be evaluated within the context of the patient's overall health and severity of illness.
Evenity Is Not for Everyone
While Evenity can be an excellent treatment option in carefully selected cases, it is not intended for women with mild bone loss or early-stage osteoporosis.
According to Dr. Goldstein, this medication should be viewed as an important "arrow in the quiver" for clinicians treating women with severe osteoporosis and a history of fractures.
Evenity is administered as a monthly injection and can provide substantial benefits for patients facing a high risk of future fractures. However, like all powerful medications, it carries potential risks.
The most concerning findings from clinical studies involved a statistically significant increase in cardiovascular events among some patients. These included higher rates of heart attacks, strokes, and even sudden death compared with certain comparison groups.
Because of these potential risks, careful patient selection is essential. Physicians must evaluate an individual's fracture risk, cardiovascular health, medical history, and treatment goals before determining whether Evenity is appropriate.
For women with severe osteoporosis and previous fractures, the potential benefits may outweigh the risks. For women with less advanced disease, other therapies may represent safer and more appropriate options.
The Importance of Personalized Bone Health Care
One of the most important lessons from modern osteoporosis treatment is that there is no one-size-fits-all solution. Each woman's medical history, fracture risk, family history, bone density results, and overall health profile are unique. Effective osteoporosis management requires individualized assessment and treatment planning.
This is why consultation with an experienced menopause and osteoporosis specialist is so valuable. Understanding when lifestyle modifications are sufficient, when medications should be considered, and which treatment option is most appropriate requires specialized expertise.
Bone health should not be addressed only after a fracture occurs. Preventive strategies, early screening, regular bone density testing, adequate nutrition, weight-bearing exercise, and appropriate medical intervention can help preserve independence and quality of life for decades to come.
Many women assume that significant bone loss begins only after menopause. However, research has shown that changes in bone health often start during perimenopause, the transitional period leading up to menopause.
Perimenopause and bone health.
Generally speaking, Evenity is not used for perimenopausal women. Dr Goldstein, a Perimenopause Specialist NYC, women need to be aware that Perimenopause can affect their bone health. Perimenopause can begin several years before a woman's final menstrual period. During this time, estrogen production becomes increasingly unpredictable. Some months estrogen levels may be quite high, while in other months they may decline substantially. Although women are still producing estrogen overall, these hormonal fluctuations can have important effects on bone metabolism.
Bone is constantly undergoing remodeling, with old bone being removed and new bone being formed. Estrogen plays a critical role in maintaining balance between these two processes. As estrogen levels become less stable during perimenopause, the rate of bone breakdown can begin to outpace the rate of new bone formation. As a result, some women start losing bone density even before they officially reach menopause.
Studies have demonstrated that the most rapid period of bone loss often occurs during the late perimenopausal years and the first several years after menopause. In fact, women can lose a significant percentage of their bone mass during this relatively short window. Because this bone loss is silent and painless, many women are completely unaware it is occurring until a bone density test reveals osteopenia or osteoporosis.
The risk is particularly important because peak bone strength is achieved much earlier in life. Once bone loss begins during perimenopause, rebuilding lost bone becomes more challenging than preserving it in the first place. This is why many experts emphasize the importance of evaluating bone health before menopause rather than waiting until significant bone loss has already occurred.
Perimenopause can also indirectly affect bone health through symptoms that interfere with healthy lifestyle habits. Sleep disturbances, night sweats, fatigue, mood changes, and decreased physical activity are common during this stage of life. Women who are exhausted from poor sleep may exercise less frequently, while others may experience changes in diet, weight, or overall health habits that can contribute to declining bone strength.
Additionally, age-related loss of muscle mass often begins during the perimenopausal years. Strong muscles help support healthy bones and reduce the risk of falls. As muscle mass declines, fracture risk may increase even before significant osteoporosis develops.
Fortunately, there are steps women can take during perimenopause to protect their bones. Weight-bearing exercise, resistance training, adequate calcium intake, sufficient vitamin D levels, avoidance of smoking, moderation of alcohol consumption, and maintaining a healthy body weight can all contribute to stronger bones. Women with additional risk factors, such as a family history of osteoporosis, previous fractures, long-term steroid use, or certain medical conditions, may benefit from earlier screening and monitoring.
Dr Goldstein, a top Perimenopause Specialist NYC says that the key message is that bone health should not become a concern only after menopause occurs. Perimenopause represents an important opportunity for prevention. By identifying bone loss early and taking appropriate action, women can significantly reduce their risk of osteoporosis and fractures later in life, helping to preserve mobility, independence, and overall quality of life as they age.
Seeking Expert Guidance
For women concerned about menopause-related bone loss, osteoporosis prevention, or treatment options such as Evenity, expert evaluation is essential.
Dr. Steven R. Goldstein is recognized as a leading Menopause Specialist NYC and Osteoporosis Specialist in NYC. A past President of both the International Menopause Society and North American Menopause Society and a Certified Menopause Practitioner, he has spent decades helping women understand the effects of menopause and perimenopause and make informed decisions about their long-term health.
Women interested in learning more about osteoporosis, menopause and perimenopause management, bone density testing, and advanced treatment options are encouraged to schedule a consultation.
