Introduction: Why early menopause and fractures matter
Imagine Sarah, a 45-year-old teacher, who experienced menopause earlier than expected. She stays active, eats well, and feels healthy—yet at her last health check, she was surprised to learn she has an increased risk of bone loss and fractures.
Many women like Sarah are unaware that early menopause (before age 45) can raise the risk of osteoporosis and fractures. Bones become more fragile as oestrogen levels fall, but research is now exploring whether starting anti-resorptive therapy earlier—before bone density is significantly low—may help prevent fractures.
In this article, we’ll explore:
- Why early menopause affects bone health
- What new trials are teaching us about early therapy
- Practical steps women can take now
- How the London Osteoporosis Clinic (LOC) supports personalised bone health care
Why this matters for bone health
Oestrogen plays a vital role in maintaining bone strength. When menopause arrives early, the loss of oestrogen happens sooner and lasts longer, leading to:
- Faster bone loss compared to women with typical menopause timing
- Higher lifetime risk of osteoporosis
- Increased risk of fractures—even in women with “normal” bone mineral density (BMD) in early years
Traditionally, doctors waited until bone mineral density scans (DEXA) showed osteoporosis before prescribing anti-resorptive treatment. But growing evidence suggests this might be too late. By the time osteoporosis is visible on a scan, substantial bone strength may already be lost.
At LOC, our philosophy is prevention first. Detecting risks early, personalising treatment, and empowering women with knowledge can delay or even prevent osteoporosis.
What is anti-resorptive therapy?
Anti-resorptive medicines slow down bone breakdown. Common types include:
- Bisphosphonates (e.g. alendronate, risedronate)
- Denosumab (injection given every 6 months)
- Selective oestrogen receptor modulators (SERMs)
These medicines are effective at reducing fractures in women with established osteoporosis. But can they work earlier—before severe bone loss occurs? That’s the question clinical trials are now investigating.
Early menopause and fracture risk: the research
Recent studies are focusing on whether starting anti-resorptive therapy earlier can protect women with early menopause from fractures, even if their bone scans do not yet show osteoporosis.
Key findings so far:
- Bone strength is more than BMD: Bone quality, micro-architecture, and turnover all matter. A “normal” scan does not always mean low risk.
- Longer exposure to low oestrogen = higher lifetime risk: Early menopause accelerates this.
- Ongoing trials: Researchers are studying whether early therapy reduces fracture incidence over 10–20 years, particularly in women with risk factors such as family history, low weight, or lifestyle factors (smoking, low activity).
For patients, this means discussions about personalised risk assessment are more important than ever.
(Reference: NHS guidance on menopause and bone health, WHO osteoporosis factsheet, and peer-reviewed journals on menopause and fractures.)
Practical steps women can take now
While research continues, there are proven steps women with early menopause can take to protect bone health:
1. Get a bone health assessment
- DEXA scan for bone mineral density
- FRAX or QFracture score for fracture risk
- Vitamin D, calcium, thyroid, and hormone levels checked
👉 At LOC, we offer comprehensive assessments tailored to each woman’s risk profile.
2. Lifestyle strategies that matter
- Nutrition: Ensure 700–1,000 mg of calcium daily (dairy, leafy greens, fortified foods) + vitamin D supplementation if needed.
- Exercise: Weight-bearing and resistance training are powerful in building bone and muscle strength.
- Lifestyle choices: Avoid smoking, reduce alcohol, maintain a healthy weight.
3. Consider hormone replacement therapy (HRT)
For women with premature or early menopause, HRT is often recommended until the average age of menopause (~51 years). It protects bones and improves overall health.
4. Discuss medication options early
If risk factors are high, doctors may recommend anti-resorptive medicines earlier than usual—especially if lifestyle measures alone may not be enough.
A real-world perspective
At London Osteoporosis Clinic, we have seen women like Sarah who, despite “normal” scans, sustained low-trauma fractures due to early menopause. Early intervention with HRT, lifestyle optimisation, and in some cases anti-resorptive therapy, helped them prevent further fractures and live confidently.
Our approach is:
- Individualised: No “one size fits all”—every patient’s risk profile is different.
- Preventive: We aim to protect bone strength before fractures occur.
- Holistic: Bone health, muscle health, nutrition, and lifestyle are integrated.
Conclusion: Protecting bone health in early menopause
Early menopause can silently increase fracture risk long before osteoporosis appears on a scan. New research is asking an important question: Should anti-resorptive therapy be started earlier, before significant bone loss is visible?
While trials continue, there are many things women can do today—get assessed, strengthen their bones through lifestyle changes, consider HRT, and discuss preventive therapy with their doctor.
👉 At London Osteoporosis Clinic, we believe in empowering women to take control of their bone health early. If you have experienced menopause before 45 or have risk factors for fractures, we encourage you to book a consultation and explore your personalised prevention plan.
Book an appointment with LOC
Explore our Bone Health Blog about a lifetime blueprint for Bone Health
