Why are women more at risk of developing osteoporosis?
Did you know that around 6.2 million Australians over 50—equivalent to 67% of this age group—have either osteoporosis or osteopaenia? According to Healthy Bones Australia’s 2024 Burden of Disease analysis, 23% of these individuals have progressed to a formal diagnosis of osteoporosis. Globally, the International Osteoporosis Foundation estimates that osteoporosis affects one in three women and one in five men over the age of 50.
Despite these staggering statistics, osteoporosis remains a condition that receives far too little attention. Many people underestimate its seriousness—largely because the consequences, namely fractures, don’t seem urgent until they happen. But fractures, particularly hip fractures, can lead to significant loss of independence and even life-threatening complications in older adults. In other words, osteoporosis is far from a “normal” part of ageing—it’s a preventable health issue that deserves far more awareness.
So what is osteoporosis and why should I care?
Osteoporosis is a condition where bones become weak, brittle, and porous. As bone density and structural strength decline, the bones are no longer able to withstand normal stress. This means fractures can occur from minor incidents—such as a small fall, a bump, or even everyday movements like bending, lifting, or coughing. The most common fracture sites are the hip, spine, and wrist.
Osteopenia is the stage between normal bone density and osteoporosis. It indicates that bone density is lower than ideal for your age, but not low enough to meet the criteria for osteoporosis. It’s an important early warning sign that intervention is needed to prevent further decline.
The most serious concern with osteoporosis is the risk of fragility fractures—breaks that occur from forces that would not normally cause a fracture in healthy bone, such as a simple fall from standing height. Hip fractures in particular can be life-changing. While surgery is typically required, the greatest risks arise afterwards: reduced mobility, loss of independence, and a cascade of complications including muscle wasting, pressure injuries, blood clots, and pneumonia. For many older adults, this can trigger a significant decline in overall health and quality of life.
But why are women more affected by this than men?
Well, there are a few reasons but a main one is perimenopause/menopause and the loss of estrogen.
Hormonal differences
Estrogen plays a crucial role in protecting bone density because it helps regulate the natural balance between bone breakdown and bone formation. To understand this, it’s important to remember that bone is living, dynamic tissue—not a static structure. Throughout life, bones undergo continuous remodelling:
Osteoclasts break down old or damaged bone
Osteoblasts build new bone to replace it
When this cycle is in balance, bones stay strong, resilient, and able to repair microdamage from daily movement.
In osteopaenia and osteoporosis, this balance is lost. More bone is broken down than rebuilt, resulting in thinner, weaker, and more fragile bones.
Estrogen helps prevent this by:
Slowing the activity and lifespan of osteoclasts, reducing bone breakdown
Supporting osteoblast survival, allowing them to build new bone for longer
When estrogen levels fall during perimenopause and menopause, osteoclasts become more active and numerous, while osteoblast activity declines. The result is a surge in bone loss—which is why many women lose 10–20% of their bone density within the first 5–7 years after menopause.
Structural differences
Women typically have smaller and thinner bones than men, which essentially means that they have a lower bone mass reserve from the start. We all (women and men) lose bone gradually once we have reached our peak bone mass in our mid 20s to 30s, but many women start off with less than what men have, plus they then experience the estrogen loss in their 40s or 50s. This means age-related bone loss has a greater impact on women over time.
Pregnancy and breastfeeding
Calcium and vitamin D are used by the baby during pregnancy and breastfeeding. If dietary intake is insufficient, the body can pull calcium from the mother's bones. Most women completely recover this loss, but low nutrient intake, low body mass, or repeated pregnancies close together may increase long-term risk.
Lifestyle factors
Low dietary intake of calcium, protein and other nutrients needed for bone building. If there is not enough calcium in the diet, the body will literally pull it out of the bones as correct calcium levels are critical for our survival.
Other factors include:
Vitamin D deficiency or insufficiency
Low muscle mass
Higher rates of thyroid and autoimmune conditions amongst women
Chronic dieting or low-energy availability
All of these will reduce bone strength over time.
Family History
A mother or grandmother with osteoporosis or a history of hip fractures significantly increases risk.
As you can tell, women are significantly more vulnerable to osteoporosis—and this risk begins much earlier than most people realise. Hormonal shifts, life-stage transitions, and biological differences all influence how a woman’s bones change across her lifetime. Understanding these factors is the first step in protecting long-term bone strength.
By midlife, many women are already experiencing changes in bone density—often without any symptoms. The good news? Osteoporosis/osteopaenia is highly preventable. With the right nutrition, lifestyle support, targeted supplementation, and early assessment, you can build stronger, healthier bones at any age.
If you have been diagnosed with osteopaenia or osteoporosis, it’s not too late to work on your bone density and strength either. Whilst medications have their place, lifestyle and nutrition play crucial roles too. If you would like to find out more about what you can do to prevent osteopaenia or osteoporosis, book in for an appointment here.
