It’s becoming increasingly obvious that we don’t fully understand menopause — even those of us experiencing it, but especially those on the outside. The symptoms most commonly associated with this phase of life are hot flashes and sleeplessness, but that’s just the tip of the iceberg. In order to fully embrace this change, we have to wholly understand what’s coming.

An extremely serious but invisible symptom of menopause is bone loss. Unfortunately, up to 20 percent of bone loss in women occurs during menopause (as if you didn’t have enough to worry about). According to the Mayo Clinic, bone loss can lead to an increased risk of fractures. If that isn’t scary enough on its own, you should probably know that these fractures can occur without falling since your vertebrae can gradually weaken to the point of collapsing.

Katie asked her OB-GYN, Dr. Rebecca Brightman, MD, for some advice on exercises and supplements for bone density — and which ones might work best. Bone health becomes increasingly important as we age, so don’t skip this valuable guidance from an expert source.

Katie Couric: Let’s talk about menopause’s effects on bone health. One of our readers, Mary, asks: “What are the best therapies for bone health other than HRT?” And I think she’s wondering if there are any supplements or medications she can take to support bone health during this time. And what about dietary changes? Actually, I’m really glad she asked this question because I do a lot of the things you recommend in terms of exercise — I do Pilates and weight-bearing exercises — but should women be taking supplements or pills to increase their bone health? Should I be taking calcium, or drinking milk? I’ve heard it all at this point.

Dr. B.: I feel that women should ideally get their nutrition through food. I’ve had so many women come into my office with a little Ziploc bag filled with all sorts of supplements, but that’s not necessarily going to solve the whole problem.

One should receive calcium through their diet, but it’s really hard for women to get all the calcium that they need. So I like to address which foods contain calcium: Obviously, dairy products do, but many women prefer not to consume traditional dairy. Or, with age and frequently in menopause, many women become lactose intolerant. Nowadays, nut milks are, for the most part, fortified with both calcium and vitamin D. And one might find a little calcium in broccoli, kale, and almonds, but they should not be the sole source of calcium for somebody who’s not having dairy or drinking fortified, non-dairy milk. Then, taking a calcium supplement isn’t a bad idea. But I don’t like that to be somebody’s sole source of calcium.

There’s some data showing that too much calcium really is not good for the heart, and can contribute to kidney stones. Some women are at increased risk for developing kidney stones, so that has to be evaluated, especially if somebody is seeing a clinician for the management of bone loss and the doctor recommends that they take calcium supplements or get a full 1200 milligrams per day.

Are there any other vitamins or minerals women should be aware of when it comes to preventing bone loss?

There’s interesting news about vitamin D: It’s very important for calcium absorption from our G.I. tract. Sun exposure will increase our body’s ability to synthesize vitamin D, and certain foods in our diet are enriched with vitamin D, like those plant-based milks. Regardless, women should have their vitamin D levels checked by their doctor, and if it’s determined that they need vitamin D supplements, they should take them.

But a new study just showed that excessive amounts of vitamin D will not help the bone — there’s just no benefit. So a woman should know her vitamin D level and take supplements if appropriate, but don’t take supplements just as an experiment.

To increase the absorption of calcium, should you take calcium supplements that have vitamin D added to them?

Yes. Most calcium supplement tablets do contain vitamin D, and that’s fine. That might not be the case for gummy calcium, though. Regardless, I wouldn’t grab extra vitamin D just because it might be good for your bones. Check with your doctor first.

I’m happy to report that bone density is one area I really stay on top of. But, what are weight-bearing exercises exactly? And why are they so good for your bones, Dr. Brightman?

That’s a great question. It’s funny, as doctors, we always talk about weight-bearing exercises. But what are we actually talking about?

So, there is an absolute correlation between muscle mass and bone density. Weight-bearing exercises would include holding planks for arm strength but also for core strength because you’re really working your abs. And with lifting weights, I’m not talking about kettlebells or eight to 10-pound weights — I’m suggesting small two to three-pound weights with repetitive contractions of these muscles that will help with definition. I also recommend barre workouts because they create long lean muscles. I think it’s a great system and it works on both muscle and bone density.

Also, anything that works on balance — like balancing on one leg — that’s a weight-bearing exercise for the opposite leg, and it’s really hard. One thing we all have to realize with age is that the way we would work out when we were 30 is very different from how we should in our 50s, 60s, and 70s. You don’t want to hurt yourself, but if you’re working out with light weights and using resistance bands, you’re allowing yourself to work out safely and optimize both your muscle and bone density.

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The information provided on this site isn’t intended as medical advice, and shouldn’t replace professional medical treatment. Consult your doctor with any serious health concerns.