Bone health after 40: osteoporosis risk and the DEXA scan

Key takeaways

• Bone loss speeds up when estrogen falls, and Indian women reach menopause earlier on average, at about 46.7 years in data cited by the Indian Menopause Society.
• Osteoporosis is silent. The first sign is often a fracture of the wrist, spine or hip after a minor fall.
• A DEXA scan is a quick, low-dose X-ray. A T-score below -2.5 means osteoporosis; between -1 and -2.5 means osteopenia.
• Calcium from food, enough vitamin D, strength and impact exercise, and not smoking all protect bone.
• Medicines, including hormone therapy in suitable women, are prescription decisions made after assessment.

Why does menopause affect your bones?

People think of bone as something fixed, like the steel inside a building. It is not. Bone is living tissue. Every single day, old bone is broken down and new bone is laid down. I explain it like a bank account: withdrawals and deposits happening all the time. Estrogen keeps that account in your favour. When estrogen falls in the years around your last period, the withdrawals start to win, and bone density can drop rapidly, as the NHS explains.

This matters even more for Indian women, for two reasons. First, the Indian Menopause Society's osteoporosis guideline notes that Indian women reach natural menopause earlier on average, at about 46.7 years, so we live more years without estrogen's protection. Second, the same guideline reports that most Indian postmenopausal women eat well under 400 mg of calcium a day, and vitamin D deficiency is common across all age groups, even in sunny Mumbai.

The International Osteoporosis Foundation estimates that about 1 in 3 women over 50 will have an osteoporotic fracture in their lifetime. A hip fracture at 70 can take away a woman's independence. A spine fracture can mean lost height, a stooped back and long-term pain. That is why I want women thinking about bone in their 40s, not after the first break.

Am I at higher risk?

Some women lose bone faster, or start with less in the account. The NHS lists these risk factors:

• Menopause before 45, or a hysterectomy before 45, especially if the ovaries were removed (see early menopause)
• Periods that stopped for more than six months because of heavy dieting or over-exercising
• Long-term steroid tablets, and some breast cancer medicines that lower hormones
• A BMI of 19 or less
• A parent who broke a hip, or a family history of osteoporosis
• Smoking and heavy drinking
• Long periods of inactivity or bed rest
• An overactive thyroid, overactive parathyroid glands, rheumatoid arthritis, or conditions that reduce absorption such as coeliac disease

If two or three of these apply to you, please don't wait for a certain age. Tell your doctor.

What is a DEXA scan, and when should I have one?

DEXA (dual-energy X-ray absorptiometry) is a scan of your hip and lower spine while you lie still on a padded table. It uses a much lower dose of radiation than a standard X-ray, says the NHS, and in most cases you stay fully clothed (remove metal such as zips, hooks and jewellery). It is not done in pregnancy.

The Indian Menopause Society suggests a central DEXA of the spine and hip for:

• All women five or more years past menopause
• Women less than five years past menopause who have one major risk factor, or more than two minor ones

It does not recommend scanning every woman in the general population, because a targeted approach based on risk is more useful. I agree. I ask about your history first and order DEXA only when the result will change a decision.

How do I read my DEXA report?

Your report compares your bone density with that of a healthy young adult. That comparison is the T-score.

You may also see a Z-score, which compares you with women of your own age. A low Z-score can point to another cause of bone loss that needs checking.

Doctors often add a fracture risk tool called FRAX, which combines your age, weight and risk factors to estimate your 10-year chance of a break. The Indian Menopause Society notes that FRAX has an India version, but Indian fracture data is still limited, so I use it alongside clinical judgement, never on its own.

What actually helps your bones?

Food first for calcium. The Indian Menopause Society advises more than 800 mg of calcium a day after menopause. The Endocrine Society of India's 2026 consensus guidance sets 1,000 mg a day for adults and says food should come first, with supplements only when diet falls short. Good Indian sources:

• A glass of milk (200 ml has about 250 mg) or a bowl of curd or buttermilk
• Ragi (nachni): 100 g has about 344 mg, so nachni bhakri or ragi dosa counts
• Paneer, til (sesame) chutney or til laddoo, rajgira
• Dals, chana, rajma and green leafy vegetables like methi and amaranth (chawli)

If you do need a supplement, the Indian Menopause Society advises taking no more than 500 mg at a time, spread through the day.

Vitamin D. Most of us in Mumbai and Thane work indoors, use sunscreen and commute in closed transport, so levels are often low. A simple blood test tells you where you stand. The dose to correct a deficiency is decided by your doctor.

Load your bones. Bones respond to weight and pull. That is literally the signal they need to stay strong. Brisk walking, climbing stairs, and above all strength training two or three days a week help maintain density and build the muscle and balance that prevent falls.

Stop smoking and keep alcohol low. Both speed up bone loss.

Prevent falls. Good lighting at night, a mat in the bathroom, and fixed loose rugs matter more than most people think.

For a full eating plan, see our Indian diet guide for perimenopause.

Where do medicines fit in?

If your fracture risk is high, food and exercise alone may not be enough. There are several classes of bone medicine, and the choice depends on your scan, your age, your kidneys, your teeth and your other health conditions.

For women under 60 or within 10 years of menopause who also have symptoms like hot flushes, menopausal hormone therapy can help protect bone. In November 2025 the US FDA began removing broad boxed warnings from these products and now advises starting systemic therapy before 60 or within 10 years of menopause, while keeping a warning for estrogen-alone use in women who have a uterus. Whether it suits you is a prescription decision made after a full assessment of your personal risks.

How I approach this at Dr Tvacha

At Cocoon × Dr Tvacha in Thane West, bone health is part of the Midlife Women's Health Check within The Right Stop Programme. I go through your history and risk factors first, then order only the tests you need, with DEXA where indicated, and we fix a review at three months and then yearly. Your bones carry you for the next thirty or forty years. They deserve a plan.

Written by

Dr Anagha KarkhanisGynaecologist and Fertility Specialist · Reg. No. 2006/02/1187

Leads midlife women's health at Cocoon × Dr Tvacha, Thane.