Estrogen plays a protective role in bone health. When estrogen levels decrease, such as after menopause, your risk of osteoporosis and bone loss rises. There are steps you can take to reduce your risk.

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Estrogen is a hormone that plays a role in several different functions, including the work of osteoblasts, the cells that regulate bone remodeling. During menopause, estrogen levels drop significantly. This adversely affects osteoblasts and leads to a major imbalance in the bone remodeling prosses.

When osteoblasts don’t produce as much new bone tissue as they used to it causes your bones to weaken and leads to osteoporosis.

The word osteoporosis means porous bone. Internally, bones have a structure similar to a honeycomb, which helps them be strong but also lightweight. With osteoporosis, the “holes” in your bones become larger, and your bones lose density. This weakens your bone structure and increases your chance of fracture.

This article will examine the effects of estrogen on bone health, help you evaluate your risk of postmenopausal osteoporosis, and look at treatment and prevention strategies like estrogen replacement therapy.

Estrogen is typically the most abundant sex hormone in the female body. It serves many functions, including maintaining healthy bones.

Healthy bone is in a continual state of remodeling. Your body reabsorbs old bone cells and then produces new bone cells to replace them. This balance between the loss of old bone and the creation of new bone is very important. When your body can’t produce enough new bone to balance the scale, it leads to bone loss and osteoporosis.

Estrogen plays an important role in the bone remodeling process. Cells called osteoclasts are responsible for reabsorbing old bone, and cells called osteoblasts help create new bone. When estrogen levels drop, your osteoblasts produce less new bone than they used to.

Researchers still don’t know exactly why estrogen is so essential to the bone remodeling process. They believe that several molecular factors may be at play. These may include:

  • how estrogen signals and binds to bone cells
  • how estrogen encourages stem cells to form osteoblasts
  • An immune response involving T-cell activation

The most common cause of low estrogen levels is menopause. Typically, menopause occurs as a natural part of aging after someone has had their final menstrual period. But menopause can also occur after certain surgeries, conditions, and treatments that impact the ovaries.

Perimenopause is a transitional span of time before menopause, which typically lasts about 4 years.

Overall, estrogen levels decline during perimenopause, but levels are also fluctuating during this time. This means your estrogen levels can go up and down for a while. But as you approach menopause, your estrogen levels will drop persistently.

Your bone mass will start to decrease long before you reach menopause. Peak bone mass typically happens in your third decade. Your bone mass may deteriorate more quickly during perimenopause, leading to lower bone density and a higher risk of fracture. But after menopause is when most people see the sharpest decline in bone density.

If your bones lose enough density, you will develop osteoporosis.

In the United States, 10 million people live with osteoporosis. Women account for 80% of diagnoses and the condition affects about 1 in 4 women age 65 or older. Generally, the risk of osteoporosis increases with age. About 1 in 3 women will break a bone due to osteoporosis in their lifetime.

There are several reasons women are more prone to osteoporosis, including:

  • a sharp decline in estrogen during menopause, causing bone loss
  • generally having smaller and thinner bones
  • a higher rate of lactose intolerance, making it difficult to get enough calcium

While some factors are beyond your control, others can be influenced. Common osteoporosis risk factors include:

  • getting enough calcium and vitamin D through supplementation
  • getting enough physical activity and exercise
  • not smoking
  • limiting alcohol intake

These days, there are alternative options to help prevent bone loss, so estrogen therapy is not usually the first choice treatment for bone loss.

The Food and Drug Administration (FDA) used to recommend estrogen therapy, also called hormone replacement therapy (HRT), for the treatment of osteoporosis. Then they reversed their recommendations due to concerns over potential health risks associated with this treatment.

Risks of HRT may include:

Medications called selective estrogen receptor modulators (SERM) are growing in use as a safer alternative to HRT. SERMs affect estrogen receptors in your body to either block or promote their work. In the case of bone, they would either encourage or prevent the work of osteoblasts and osteoclasts in building and reabsorbing bone.

Leading a healthy lifestyle can help you maintain healthier bones after menopause.


Resistance exercises, like lifting weights, or weight-bearing exercises that cause you to resist gravity, help build, maintain, and prevent bone loss. Weight-bearing exercises might include:

  • walking
  • hiking
  • jogging
  • tennis
  • dancing

If you have osteoporosis, avoid high impact exercises to lower the risk of breaking a bone.

Reduce alcohol consumption

While researchers are still unclear on the effects of light to moderate drinking, some research has indicated that heavy alcohol use increases the risk of osteoporosis. Alcohol interferes with the body’s ability to absorb nutrients, calcium, and vitamin D, which are critical for bone health.

Stop smoking

It’s unclear whether the link between smoking and osteoporosis is due to smoking or other risk factors associated with smoking. People who smoke usually have several other risk factors that increase their chance of developing the condition. Quitting smoking may remove these risk factors.


Calcium and vitamin D are essential contributors to strong bones. Getting enough calcium and vitamin D through your diet or other sources may become more challenging if you’re lactose intolerant or avoid the sun. Calcium supplements have risks so it’s important to talk with a doctor about adding supplements to your diet.

Estrogen is a vital hormone in the female body. It contributes to the work of osteoblasts and osteoclasts that continually remodel bone to keep it healthy.

As women reach perimenopause, their estrogen levels decrease naturally. This allows for bone reabsorption but not regeneration. The result is weaker, less dense bones that can more easily fracture and break.

Medications called SERMs are growing in use as a treatment for osteoporosis. Some lifestyle choices can also help protect your bones.