Risa Kagan, MD, on bone health across a woman's lifetime

Bone health deserves attention across a woman’s entire lifetime, and the menopause transition is a critical window when bone loss accelerates, according to Risa Kagan, MD, FACOG, CCD, MSCP, clinical professor in the department of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco, and a physician with Sutter East Bay Medical Group in Berkeley, California. Kagan spoke in an interview at The Menopause Society Annual Meeting 2026 in San Diego, California.

The menopause transition as a critical window for bone loss

Peak bone mass is reached by about age 25 or 30, Kagan said, supported by a healthy diet, physical activity, and avoiding or taking precautions with high-risk medications. Women maintain that bone mass through their reproductive years, but the Study of Women’s Health Across the Nation (SWAN) has shown that bone loss begins before the final menstrual period.

Over the menopause transition, women can lose 10% to 12% of their bone mass, followed by further age-related loss.

“SWAN has really told us that you need to pay attention during this critical window of time and look at bone health over a lifetime,” Kagan said.

The stakes are high, she said: an average 50-year-old woman has a 1 in 2 chance of an osteoporotic fracture in her remaining lifetime, and a hip fracture carries roughly a 20% risk of mortality.

Preserving bone mass

Preserving bone mass takes more than aerobic activity, Kagan said. Strength training to maintain muscle is key, because muscle and bone interact.

“Muscle and bone talk to each other,” Kagan said, noting that muscle mass declines with age. She also cautioned about the effects of GLP-1 medications on bone and muscle mass.

For fall prevention, Kagan recommended simple balance exercises. “I tell women just stand on one leg, look in the mirror and brush the teeth at night, and alternate sides to really work on balance,” she said.

On diet, Kagan said eating calcium is the best way to reach a target of about 1,200 mg per day, depending on the guideline. Because the average American woman gets roughly 600 to 700 mg from her diet, she advised supplementing only up to that target rather than adding 1,200 mg on top, and she called vitamin D essential for bone mineralization. Calcium and vitamin D alone, however, are not a treatment for osteoporosis, Kagan said.

View more of our coverage from The Menopause Society Annual Meeting.