How do bones change after menopause? Which habits matter?

After menopause the body makes less oestrogen, so bone is broken down and rebuilt faster and bone mass falls faster for a number of years. Habits worth paying attention to from today: weight-bearing exercise, strength and balance work, meals from all the food groups, walks in gentle sunlight, and a home where you can walk steadily.

All of these are things you can do yourself in everyday life, and several fit together, such as a brisk walk in the gentle morning sun.

How do bones change after menopause?

Less oestrogen

The UK's NHS explains that after menopause the ovaries almost stop producing oestrogen, which has a protective effect on bones. As a result, women lose bone more rapidly for a number of years after menopause.

For night sweats that wake you up around menopause, see Menopause night sweats keep me awake. How can I cope?

Bone is always being broken down and rebuilt

The NIH ODS fact sheet from the US National Institutes of Health explains that bone is not static: it is constantly being broken down and rebuilt. In men, the amount of calcium in the body stays fairly constant through adulthood, while in women it starts to drop at the start of menopause because lower oestrogen speeds up this turnover.

About 1% a year

The NIH ODS says that, on average, women lose about 1% of their bone mineral density per year after menopause. The change is gradual, so daily habits are a long-term matter you can keep up over time.

What kind of exercise suits life after menopause?

NIAMS, part of the US National Institutes of Health, says exercise offers benefits for bone at any age and strengthens both muscles and bones in adults. It recommends combining three types.

How often

The NHS advises adults to do strengthening activities that work all the major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms) on at least 2 days a week, and at least 150 minutes of moderate activity a week, spread over 4 to 5 days or every day. Its moderate examples include brisk walking, water aerobics, cycling and dancing.

Making it part of your day

• Take the stairs instead of the lift.
• Walk briskly around your neighbourhood or a park in the morning or evening.
• Use resistance bands at home, or join a tai chi group in the park.
• Try shifting your weight backward and forward while you brush your teeth, with something to hold on to nearby.

Before you start

The NHS advises speaking to a doctor first if you have not exercised for some time or have health conditions or concerns. Then start gently and build up.

How should I plan meals and get sunlight?

Meals from all the food groups

The NHS describes a healthy, balanced diet together with exercise as the building blocks of healthy bones, and lists foods such as dairy products, green leafy vegetables, soya beans and tofu, fortified plant drinks, nuts, and fish where you eat the bones. In a Thai kitchen, that means:

• Milk, yoghurt, or lactose-free milk if milk upsets your stomach
• Green leafy vegetables such as Chinese kale, mustard greens and cha plu leaves
• Firm tofu, soybeans and sesame
• Small fish and canned fish eaten with the bones

Many of these foods contain calcium, which is needed for the maintenance of normal bones and teeth.

Gentle sunlight

A Ramathibodi Hospital (Mahidol University) infographic says the skin can make vitamin D when exposed to gentle sunlight, and suggests walking or jogging in the gentle morning or evening sun for 15 to 20 minutes a day, 3 to 5 days a week. A brisk morning walk gives you weight-bearing exercise and sunlight at the same time.

Alcohol

The NHS advises not drinking too much alcohol, as part of its advice on staying steady on your feet.

How can I set up my home and routine to stay steady on my feet?

The NHS suggests these ways to lower the chance of falling:

Small changes in a Thai home

• In a wet-floor Thai bathroom, use a non-slip mat, as the NHS advises.
• Choose indoor slippers with a grippy sole that stay on your feet.
• Fit rails on the stairs and in the bathroom.
• Keep fan cables, charger leads and sliding doormats out of walkways.

How can I fit these habits into a week?

This is an illustration of how the habits can fit into ordinary life, not a personal programme.

If you are worried about your bones, talk to a doctor.