Why Wait Until 65? Menopause and Bone Health: The Case for Earlier Screening and HRT

Monica Bell
13 minutes ago
3 min read

The Problem With Waiting

Women generally begin bone screening when they turn 65 and are eligible for Medicare. Why? Because Medicare will pay for bone density screening every two years. According to the U.S. Preventive Services Task Force, BMD tests are recommended for:

All women ages 65 and older
Younger women with a higher-than-normal chance of fracture for their age

Although private insurance may cover the cost of bone density screening before the age of 65, specific criteria must be met. But bone density problems begin earlier than 65 when irreversible bone loss may already have occurred.

Bone Loss Starts Earlier Than Most Women Realize

Bone density decreases after menopause primarily due to a sharp drop in estrogen and testosterone levels, which affects bone remodeling, leading to rapid mineral loss and a higher risk of osteoporosis.

Research shows that:

Bone mineral density (BMD) often begins declining about one year before the final menstrual period. Most women enter menopause between the ages of 45 and 55.
The greatest rate of bone loss occurs during the year before menopause and the first two years afterward.
Bone loss slows after about two years but bone loss continues gradually with age.

Given this information, the first two years of menopause present a unique and critical opportunity to mitigate the effects of bone loss. Waiting until age 65 may mean missing more than a decade of preventable bone loss.

Woman strength training to support bone health during menopause

Hormone Replacement Therapy Can Help Preserve Bone

Bone health should be a part of the conversation when weighing risks and benefits of HRT. Osteoporosis has significant medical and financial consequences:

Bone Fractures: Weak bones lead to roughly 2 million breaks per year in the U.S., commonly in the hip, spine, and wrist.
Spinal Changes: Spinal compression fractures cause chronic back pain and height loss.
Severe Decline and Mortality: Hip fractures carry a 20% to 24% mortality rate within the first year.
Disability: About 40% of hip fracture survivors cannot walk on their own, and 60% still need help a year later.
Annual direct costs surpass $19 billion

Benefits and Effectiveness of HRT

Bone Density: Stops rapid bone breakdown after menopause and rebuilds or maintains strength in the spine and hip.
Fracture Reduction: Lowers the chance of breaking bones in the spine and hip by roughly 30% to 45%.
Symptom Relief: Manages common menopausal signs like hot flashes, low energy, night sweats and other troubling symptoms simultaneously.

Looking Beyond Standard Bone Density: The Trabecular Bone Score (TBS)

Standard DXA scans measure bone mineral density. Trabecular Bone Score (TBS) evaluates bone microarchitecture or quality. TBS can help identify women whose bones may be weaker than BMD alone suggests. Particularly for women with additional bone density risk factors, requesting a TBS score with the DXA can provide valuable information in informing treatment options.

Who Should Consider Earlier Bone Screening?

Earlier bone screening is reasonable to begin if you:

Are perimenopausal.
Are entering menopause or recently postmenopausal.
Have a family history of osteoporosis or hip fracture.
Have experienced an early menopause.
Have a low body weight.
Smoke or drink heavily.
Use medications that weaken bone (such as long-term corticosteroids).
Have other medical conditions that increase osteoporosis risk.

Additional Adjuncts to HRT to Increase Bone Density

Hormone replacement is the first line of attack to stop bone loss, but it isn’t the only one. A focus on consistent weight-bearing activities, supplementation, and dietary changes will not only help your bone density, but improve your overall health and well-being.

Exercise and Physical Activity

Strength training: Lift weights or use resistance bands to put stress on your bones so they grow stronger.
Impact loading: Do controlled jumps, hops, or fast walking to stimulate new bone tissue growth. Walking and hiking are also good bone-strengthening activities.
Balance training: Practice single-leg movements, Tai Chi, or yoga to improve stability and prevent falls.

Nutrition and Diet

Calcium: Aim for 1,000 to 1,200 milligrams daily from dairy, dark leafy greens, or fortified foods.
Vitamin D: Get safe sunlight exposure, take vitamin D supplements and eat fatty fish to help your body absorb calcium.
Protein: Eat enough protein to support both your muscle and bone health

Menopause and Bone Health: Don’t Wait for the Damage

If you are perimenopausal, talk with us at Optimal Hormone Health about options for bone density screening and the possibility of starting HRT. In summary, here are the reasons why:

Bone health deserves attention before age 65.
Earlier screening provides a baseline and may identify women who would benefit from preventive strategies.
The menopause transition represents a narrow but valuable opportunity to preserve lifelong bone health.