When I was growing up, it wasn’t unusual to see elderly women walking almost parallel to the ground, their backs bent sharply forward, supported by bamboo sticks or even the sturdy trunk of a tapioca plant.
At the time, we simply accepted this as 'old age'. Today, we understand that one of the major culprits behind this dramatic stooping is osteoporosis—progressive thinning of the bones. But osteoporosis is only part of the story.
Many older adults develop a forward‑bent posture because of tiny, silent compression fractures in the spine. These fractures often cause no dramatic pain and are easily dismissed as 'a bit of back strain'. Add to this the effects of lifelong physical labour, muscle weakness, genetics, diet, and normal wear‑and‑tear of the spine, and the picture becomes clearer.
How common is osteoporosis?
More common than most people realise. After age 50, one in three women will experience an osteoporotic fracture. For men, it’s one in five. These fractures can be life‑changing, affecting mobility, independence, and confidence.
Why are women more affected?
The biggest reason is oestrogen. This hormone plays a major role in maintaining bone strength. Around menopause, oestrogen levels drop sharply, and bone loss accelerates. Women can lose up to 10 per cent of their bone density in the first five years after menopause. Men, by contrast, experience a slow, gradual decline in hormones and therefore a slower rate of bone loss.
The power of early intervention
The good news is that the severe, fixed stooping we once saw so commonly is now far less frequent. Better nutrition, more awareness, and earlier treatment have made a real difference.
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Strength training, posture exercises, balance work, and adequate calcium and vitamin D all help protect bone health. These habits are not just for older adults—they matter at every age. Building strong bones early in life gives us a 'bone bank' to draw from later.
Menopause Hormone Therapy (MHT)
Most women consider MHT to help with menopausal symptoms such as hot flushes, night sweats, vaginal dryness, irritability, or brain fog. But even women without symptoms may benefit from MHT for bone protection, particularly those under 65.
Oestrogen therapy slows bone loss and supports bone formation. In many women, it significantly reduces the risk of fractures.
What about breast cancer risk?
This is a common and understandable concern. Recent reviews provide reassuring clarity:
• Using MHT for less than five years does not increase breast cancer risk.
• Oestrogen‑only therapy does not increase breast cancer risk.
• Oestrogen combined with body‑identical progesterone shows no increased risk for at least five years.
• Even with older synthetic progestogens, the increased risk was small—around eight extra cases per 10,000 women per year.
Lifestyle factors—smoking, alcohol, exercise, and weight—have a far greater impact on breast cancer risk than MHT.
How does MHT compare with other treatments?
For preventing fractures, MHT performs as well as commonly used bone‑specific medications such as bisphosphonates and denosumab. This applies to vertebral fractures, hip fractures, and fractures at other sites.
When should bone health be assessed?
Early post‑menopause is the ideal time for a bone density scan. If bone density is lower than expected, your doctor may look for other causes. If none are found, MHT or other medications may be recommended.
There is no mandatory age to stop MHT. If a woman chooses to discontinue it or if it becomes unsuitable, other medications can take over. If fractures occur despite treatment, anabolic therapies—medications that help build new bone—may be used first, followed by anti‑resorptive agents to maintain the gains.
Key takeaways
• Bone health is a lifelong investment. Nutrition, exercise, and vitamin D remain the foundation.
• MHT can prevent bone loss and reduce fracture risk, delaying or avoiding the need for bone‑specific drugs.
• Treatment choices should balance benefits and risks, and be tailored to each woman’s health, preferences, and stage of life.
Strong bones aren’t built in a day, but with steady choices, they carry us through a lifetime. Age bends us only when we let it; knowledge and action help us stand tall.
Dr Johnson Kuttiyil Johnson is a UK-trained, consultant gynaecologist & laparoscopy surgeon working in Nowra, NSW, Australia.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
