The Impact Of Menopause On The Musculoskeletal System: A Practical Overview

Key Points • Menopause is associated with a rapid decline in estrogen, which significantly affects bone, joint, and muscle health. • Bone loss accelerates during the menopause transition, with up to a 10% reduction in spine bone density within the first five years after the final menstrual period. • Menopausal hormone therapy (MHT) has been shown to be effective in preserving bone density and reducing fracture risk. • Musculoskeletal symptoms, such as pain, stiffness, and joint discomfort are common and often underrecognized during the menopause transition, sometimes leading to misdiagnosis. • Foundational strategies for preserving musculoskeletal health during and after menopause include lifestyle interventions such as strength training, balance exercises, and adequate protein and vitamin D intake. Menopause represents an important phase in a woman's reproductive life, marked by the permanent cessation of menstrual periods, signalling the end of the reproductive years. In North America, the average age of onset is 50.5 years, generally occurring between the ages of 45 and 55. Hormonal fluctuations and symptoms of hypoestrogenism—such as hot flashes, night sweats, mood and cognitive changes—can begin up to 10 years before menopause, during the perimenopausal or menopause transition. These symptoms stem from fluctuations in sex hormones, primarily estrogen, which has receptors distributed throughout the body and impacts nearly every organ system, including the bones, joints, and muscles. In this review, we will summarize the effects of hypoestrogenism on bone, joint, and muscle health during and beyond the menopause transition.