Her Bone Health — What Partners Can Do to Help

Estrogen is essential for bone maintenance. Throughout her reproductive years, estrogen promotes the activity of osteoblasts (cells that build bone) and suppresses osteoclasts (cells that break bone down). This balance keeps bone density relatively stable. When estrogen drops permanently at menopause, the balance tips dramatically toward bone breakdown. Women lose an average of 2–3% of bone density per year in the first 5–7 years after menopause — a rate that can result in up to 20% bone loss in less than a decade. This accelerated loss occurs in the spine, hips, and wrists most significantly. For some women, this trajectory leads to osteopenia (reduced bone density) or osteoporosis (severely reduced bone density with high fracture risk). The numbers are stark: 1 in 2 postmenopausal women will experience an osteoporotic fracture in their lifetime. Hip fractures are the most devastating — they require surgery, extended rehabilitation, and carry a 20% one-year mortality rate and a 50% chance of permanent disability. Spine fractures cause chronic pain and postural changes. These outcomes are largely preventable with proactive screening and intervention. The problem is that bone loss is silent — there are no symptoms until a fracture occurs. That's why screening matters, and why partners who encourage it make a tangible difference.

A DEXA (Dual-Energy X-ray Absorptiometry) scan is a painless, non-invasive imaging test that measures bone density. It takes about 10–15 minutes, involves minimal radiation (less than a chest X-ray), and produces a T-score that compares her bone density to that of a healthy 30-year-old woman. A T-score of -1.0 or above is normal. Between -1.0 and -2.5 indicates osteopenia (reduced density but not yet osteoporosis). Below -2.5 indicates osteoporosis. The FRAX tool uses the T-score along with other risk factors to calculate her 10-year fracture probability, which helps guide treatment decisions. Current guidelines recommend universal DEXA screening at age 65 for all women. However, women with risk factors should be screened earlier — at menopause or whenever risk factors are identified. Risk factors include: early menopause (before 45), family history of osteoporosis or hip fracture, smoking, excessive alcohol, low body weight, long-term corticosteroid use, certain medical conditions (celiac disease, rheumatoid arthritis), and being white or Asian. If her T-score shows osteopenia, repeat screening every 1–2 years to track trajectory. If it shows osteoporosis, treatment should be discussed immediately. The scan itself is simple — your role is encouraging her to schedule it and not let it fall through the cracks of a busy life.

Exercise is one of the most effective interventions for bone health, but not all exercise is equal. Bones respond to mechanical stress — when muscles pull on bones during weight-bearing and resistance activities, the bones adapt by becoming denser and stronger. This is called Wolff's Law, and it works throughout life. The most beneficial exercises for bone density are: weight-bearing impact exercises (walking, jogging, hiking, dancing, stair climbing, tennis), resistance training (lifting weights, using resistance bands, bodyweight exercises), and balance training (which prevents falls and therefore fractures). Swimming and cycling, while excellent for cardiovascular health, don't load bones enough to stimulate significant bone building. Strength training deserves special emphasis. Research consistently shows that progressive resistance training — gradually increasing weight over time — improves bone density at the hip and spine, the most critical fracture sites. Even modest programs (2–3 sessions per week of 30–40 minutes) produce meaningful benefits. Balance and functional movement training become increasingly important with age because the most common path to a fracture is a fall. Improving balance, reaction time, and lower body strength reduces fall risk by up to 40%. Tai chi, yoga, and simple balance exercises (standing on one leg) are surprisingly effective. Exercising together as a couple turns bone health into shared activity rather than medical compliance, making it far more sustainable long-term.

If screening reveals osteoporosis or high fracture risk, several effective treatments are available. HRT remains one of the most effective interventions for bone preservation when started near menopause. Estrogen directly slows bone resorption, and women on HRT maintain or even increase bone density. For women who are already on HRT for vasomotor symptoms, the bone benefits are an important added value. Bisphosphonates (alendronate, risedronate, zoledronic acid) are the most commonly prescribed osteoporosis medications. They work by inhibiting osteoclasts, slowing bone breakdown. Oral bisphosphonates are taken weekly or monthly; zoledronic acid is given as an annual IV infusion. They reduce fracture risk by 40–70% depending on the site. Denosumab (Prolia) is a biannual injection that inhibits bone resorption through a different mechanism. It's highly effective but requires consistent dosing — stopping can cause rebound bone loss. For severe osteoporosis, anabolic agents like teriparatide (Forteo) or romosozumab (Evenity) actually build new bone rather than just preventing loss. These are typically reserved for high-risk patients. Calcium and vitamin D supplementation are foundational but usually insufficient on their own to treat established osteoporosis. They support treatment effectiveness rather than replace it. Understanding these options helps you be an informed partner when she's making treatment decisions.

Bone health might seem abstract, but it has concrete implications for how you live together, especially as years pass. If she has osteopenia or osteoporosis, fall prevention becomes part of your household consciousness. That means securing rugs, ensuring adequate lighting (especially in hallways and bathrooms at night), keeping floors clear of tripping hazards, using non-slip mats in the shower, and being aware that icy sidewalks, uneven surfaces, and cluttered spaces carry real risk. Activities may need modification. High-impact sports, heavy lifting with poor form, or activities with high fall risk may need to be approached differently. This doesn't mean wrapping her in bubble wrap — staying active is essential — but it means choosing wisely. Nutrition becomes a shared project: ensuring adequate calcium-rich foods (dairy, leafy greens, fortified foods), vitamin D (sunlight exposure, fatty fish, supplementation), and protein (essential for bone and muscle maintenance). Cooking together with these nutrients in mind turns health management into partnership. Long-term, her bone health affects your shared future. A hip fracture at 70 can mean surgery, rehabilitation, loss of independence, and dramatically changed life plans. Investing in her bone health now — through screening, treatment, exercise, and nutrition — is investing in the active, independent future you both want.