Risa Kagan, MD, on why the menopause transition is a critical window for bone loss and how women can preserve bone mass.
News|Videos|November 11, 2026
Risa Kagan, MD, on earlier bone density testing at menopause
Author(s)Risa Kagan, MD, FACOG, CCD, MSCP
Fact checked by: Joshua Fitch, Senior Editor
Key Takeaways
- Kagan positions bone health as a multidisciplinary, prevention-focused issue for primary care and gynecology, reserving endocrinology referral for patients with multiple fractures or those needing advanced therapies such as anabolics.
- A 10% to 12% bone loss over the menopause transition is equivalent to one T-score, making the starting point critical.
Risa Kagan, MD, on bone health prevention in primary care and why baseline bone density testing should come before age 65.
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Bone health, including the bone loss tied to menopause, is well suited to prevention in primary care and gynecology, 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
A multidisciplinary approach to bone health
Bone health does not fall neatly into one specialty, Kagan said, and primary care clinicians, including family medicine physicians and internists, along with gynecologists, all have a role in addressing it. Endocrinologists are appropriate referrals for patients with multiple fractures or those who need advanced medications such as anabolics, she said, but prevention is where primary care and women’s health can act.
With the average age of menopause at 51 and many women living into their 80s and 90s, Kagan framed the postmenopausal years as a long window to protect bone mass.
“Primary care and gynecology, women’s health, is a time for really looking at prevention,” Kagan said. “Prevent that first fracture.”
Rethinking when to measure bone density
Kagan pointed to the Study of Women’s Health Across the Nation (SWAN), now entering its 30th year, which has followed women through and beyond the menopause transition.
Most guidelines recommend a first bone density scan at age 65 unless a patient has other risk factors, Kagan said. While clinicians can sometimes obtain earlier testing by citing estrogen deficiency, family history, or another risk factor, as she does in California, many patients cannot get a bone density scan before 65.
“That is too late, and I really believe that all the guidelines really need to be updated,” Kagan said, so that patients get a baseline measurement before the period of rapid loss.
A 10% to 12% loss over the menopause transition is equivalent to one T-score, she said, underscoring the importance of knowing where a patient starts.
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