Estrogen loss accelerates bone resorption. Early intervention prevents irreversible loss.
Women lose ~10% of bone density in the 5 years around menopause. ~50% of postmenopausal women will fracture and bone due to osteoporosis in their lifetime.
All postmenopausal women face risk. Higher: thin frame, smoking, family history, early menopause (<45), corticosteroid use.
All options below are real published treatments. Evidence-level reflects current clinical guidelines (NAMS / ACOG / Endocrine Society). Cost ranges are starting price estimates from $US public sources.
Monthly cost
$25-$150
Side effects
breast tenderness, spotting
FDA-approved for osteoporosis prevention in postmenopausal women with VMS. Preserves bone density when started early. Effect reverses on discontinuation.
Providers offering this: midi health, alloy womens health
Monthly cost
$10-$40 generic
Side effects
esophageal irritation, rare jaw osteonecrosis with long-term use
First-line for established osteoporosis. Reduces vertebral fractures ~50%. Strict dosing requirements (empty stomach, 30 min upright).
Contraindications: Esophageal stricture, severe renal impairment
Monthly cost
$1500 per 6-month dose
Side effects
hypocalcemia, rare jaw osteonecrosis
SubQ injection every 6 months. Useful when oral bisphosphonates contraindicated. Discontinuation can cause rebound bone loss + fractures — plan transition.
Monthly cost
$5-$20 OTC
Side effects
constipation, kidney stones if excessive
Calcium 1200mg/day + vitamin D 800-1000 IU. Supplements alone not sufficient when osteoporosis established.
Monthly cost
$0-$50
Side effects
minimal
Walking, jogging, resistance training stimulate bone formation. Required regardless of pharmacotherapy.
Routine at age 65. Earlier (50-64) if: family history of hip fracture, early menopause, long-term corticosteroid use, BMI <19, smoking, alcohol >3 drinks/day, or previous fragility fracture.
Last verified 2026-06-01. Treatment guidelines update — confirm with your clinician.