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A skeleton hanging on a door or standing in your neighbor's yard for Halloween looks like a finished structure. But the skeleton inside a living body is constantly changing. Around menopause, those changes can tip toward bone loss, often without pain or another obvious warning.

I am a skeletal biology researcher at Washington University School of Medicine in St. Louis. My work examines how hormonal and metabolic signals influence bone renewal. In my assessment, the quiet nature of bone loss makes menopause an important time to bring skeletal health into the conversation.

Bone loss can start accelerating before the final menstrual period. Natural menopause is confirmed only after 12 consecutive months without a period, when there is no other explanation. Bone loss can therefore accelerate before someone knows that their last period was their final one.

Bones are living tissues that continually renew themselves. During this process, called remodeling, cells known as osteoclasts remove old bone while other cells—osteoblasts—build its replacement. Estrogen helps regulate this renewal. As estrogen levels decline around menopause, removal can outpace replacement, contributing to bone loss and osteoporosis, a condition in which bones become more fragile and porous.

Osteoporosis can affect women and men. It becomes more common with age but can also occur in younger people. A person often has no noticeable symptoms until a fracture occurs.

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