Most menopause bone advice is about density scores and calcium. Here is something you can check this afternoon with a doorframe and a pencil, and it is one of the few signs that a fracture has already happened — because the commonest osteoporotic fracture usually causes no obvious event at all.
Where we stand: Menova is an independent publication. We sell no supplements, tests or scans, we are not your doctor, and this is general education, not a diagnosis.
The thing that gets missed
Vertebral compression fractures are the most common fracture caused by osteoporosis, and the majority are never diagnosed.
There is often no fall, no dramatic moment and no severe pain — a vertebra loses height gradually or after something minor like lifting a suitcase or a heavy sneeze. What follows is put down to age: a bit of back ache, a slightly rounder upper back, clothes hanging differently, and being shorter.
That matters for one reason. Having one vertebral fracture substantially raises the risk of the next one, and of a hip fracture. It is the single strongest signal that bone treatment should be discussed — and it is being missed in a large share of the women who have it.
What to do this week
Measure your height properly. Shoes off, heels and back against a wall, looking straight ahead, someone else marking the top of your head. Do it in the morning if you can — everyone is slightly shorter by evening.
Compare it with your peak adult height, which is usually what you were in your twenties. If you do not know, your passport, an old medical record, or simply the number you have always given is a reasonable starting point.
Write it down and repeat it yearly, because a change measured over time is more informative than a single number.
Commonly used thresholds for prompting further assessment are around 4 cm lost from peak adult height, or around 2 cm measured between visits. Thresholds differ between guidelines and services, so treat these as the order of magnitude and ask what yours uses.
Some height loss with age is normal — discs compress, posture changes. The point is not that any loss is alarming. It is that a meaningful loss is a finding rather than an inevitability, and nobody will measure it unless you ask.
The other signs
Worth knowing because they appear before or alongside the measurement:
- A rounding of the upper back that is new, or that others comment on
- Clothes fitting differently through the body while your weight has not changed
- Your ribs feeling closer to your hip bones, or a new tummy that is compression rather than fat
- Back pain that started suddenly, particularly after something trivial
- Breathlessness or early fullness when eating, in more advanced cases, because the trunk has shortened
- Standing with your heels and back against a wall and no longer being able to touch your head to it
Who should raise it sooner
The transition itself accelerates bone loss, and some situations compound it — see bone health in menopause.
- Early or surgical menopause, or menopause before 45 — see early and surgical menopause and BRCA and risk-reducing surgery
- A previous fracture from a minor fall at any point after 50
- A parent who fractured a hip
- Long-term steroids — see long-term steroids and menopause
- Low body weight, or a history of an eating disorder — see eating disorders in midlife
- Coeliac disease or other malabsorption — see coeliac disease and menopause
- Breast cancer treatment with aromatase inhibitors — see menopause after breast cancer
- Smoking and higher alcohol intake — see smoking, vaping and menopause and alcohol in midlife
What happens if you raise it
A DEXA scan measures density, and is the usual first step. What to do with the result is in what to do about a DEXA result.
Spine imaging may be added if height loss or back pain suggests a vertebral fracture, because a fracture changes the decision regardless of what the density score says. This is the part that gets skipped — ask specifically whether your spine should be looked at, not only whether your density should be measured.
The ordinary bloods, because vitamin D deficiency, coeliac disease and thyroid problems all affect bone — see which tests to ask for and our free blood test sheet.
What actually protects the spine
Resistance training, twice a week. It is the intervention that builds bone, and the years around the transition are when loss is fastest — see strength training in menopause and starting from zero.
Impact where you are able — walking maintains, but it does not load bone the way impact does. If you already have a vertebral fracture or known osteoporosis, take advice first, because some movements are not appropriate.
Enough protein, without which training builds less — see how much protein you need.
Vitamin D and calcium, corrected rather than guessed at — see vitamin D and calcium.
Not falling, which is the other half of the equation and improves far faster than density does — see falls and balance after menopause.
Hormone therapy preserves bone density, and where it is appropriate for you that is a genuine benefit alongside symptom relief. It is not usually prescribed for bone alone, and the calculation is different in early menopause — see HRT risks and benefits.
One thing to avoid
Do not start high-dose calcium on your own. More is not better, and there are cardiovascular questions around high supplemental doses that do not apply to calcium from food — see calcium supplements and the heart.
See a clinician promptly for
- Sudden severe back pain, particularly after a minor strain
- Back pain with numbness, weakness, or loss of bladder or bowel control — this is an emergency
- Height loss of a few centimetres that you have just discovered
- Any fracture from a fall from standing height after 50
What to say
"I've lost about four centimetres since my twenties and my upper back looks rounder. Could we arrange a DEXA scan — and given the height loss, should my spine be imaged for a vertebral fracture rather than just measuring density?"
That names the measurement, and asks for the step that is most often left out.
Our free printable visit prep sheet keeps it to one page, and the free 2-minute Menova self-check organizes your wider symptom picture — no account, not a diagnosis, and your answers never leave your device. The full picture is in bone health in menopause and health screening in your 50s.
This article is general education, not medical advice or a diagnosis. Height thresholds and assessment pathways differ by country and guideline. Do not begin impact exercise if you have known osteoporosis or a vertebral fracture without advice. Back pain with numbness, weakness or bladder or bowel changes requires emergency assessment.
Sources: Bone Health & Osteoporosis Foundation, NIAMS — Osteoporosis, NICE NG23 — Menopause, and NHS — Osteoporosis.