The average age of menopause is 51 years. Women over 50 have a greater risk than men of developing arthritis and osteoporosis. This is in part related to the estrogen withdrawal that women experience in perimenopause, menopause, and the post-menopausal years. 

Estradiol, the most prominent form of estrogen in the body, is a powerful anti-inflammatory hormone:

• It is known to reduce both joint pain and inflammation.
• It also helps prevent the breakdown of bone tissue. 
• It helps to repair and maintain muscle, which can explain why lean muscle mass decreases as women age.

Unfortunately, after rising and falling irregularly during perimenopause, estradiol levels rapidly decline at menopause (defined as 1 year after your last menstrual period). 

Bone density peaks at age 30 and gradually declines after that, with more rapid decline in perimenopause and menopause. The SWAN study, which followed premenopausal women through menopause and post-menopause, found that:

• Bone loss speeds up to 2% per year 1 year before the last menstrual period or 2 years before menopause. 
• Bone loss then continues at this accelerated 2% rate a couple years after menopause, before continuing at a less accelerated rate. 

When estradiol falls, women can experience a variety of musculoskeletal issues, including increased risk of the following.

Fragility Fractures 

Seventy-five percent of osteoporotic hip fractures occur in women. An osteoporotic, or fragility fracture, is when you break a bone without a major trauma — for instance, after falling from a sitting or standing height, which in a person without weakened bones would not result in a fracture.

The Women's Health Initiative and other studies have shown that estrogen-replacing hormone therapy reduces hip fracture risk by about 30% and spine fracture risk by about 40%. Menopausal hormone therapy (also called hormone replacement therapy), including either Premarin or bioidentical estradiol, improves bone density and reduces fracture risk in menopausal women. 

Joint Pain and Arthritis

Women over 50 have a 35% greater risk of knee arthritis than their male counterparts — and the risk does not become equal until the age of 80. 

The SWAN study group of postmenopausal women mentioned above was shown to have increased levels of inflammatory proteins called cytokines, which are known to contribute to the development of joint pain and arthritis, and to the breakdown of bone that contributes to development of osteoporosis.

The Women's Health Initiative showed that menopausal hormone therapy (MHT) reduced joint pain and that the pain actually came back after women stopped using MHT. 

Frozen Shoulder

Frozen shoulder primarily affects women ages 40 to 60 and is increasingly recognized as a sign of perimenopause and menopause. 

Frozen shoulder likely occurs due to inflammation of the lining of the shoulder joint, as well as an excess of cells called fibroblasts that thicken and stiffen the lining of the shoulder joint. 

Without estradiol in the picture, inflammation and the production of fibroblasts can go unchecked and occur with little to no trauma. Ongoing research is under way to better understand hormone-related prevention and treatment strategies. 

These are some steps women can take to maintain and improve muscle mass and bone density and reduce their fracture risk:

Menopausal hormone therapy. Not all women are able to or want to use MHT, but it is an effective tool for reducing the risk of osteoporosis and fractures. Talk to your doctor about whether you are a good candidate for MHT, taking into account your overall health and risk factors.

Strength training. Two to three days a week of strength training can improve hip and spine bone density and help maintain lean muscle mass. 

The LIFTMOR trial is a classic study in which women of average age 65 progressively trained to build up to high-intensity strength training. High-intensity strength training is lifting at 85% of their single repetition maximum, meaning you can do 4 to 6 repetitions with good form but not more without resting. Participants in the study — which included squatting, deadlifting, overhead presses, and jumping chin-ups —  improved their hip and spine bone density in just 8 months. 

Other studies of less intense lifting at higher repetitions also have shown bone health benefits, but there is a greater benefit at higher intensity for those who are able to train at that level.

Impact exercises. Exercises that create impact, like jumping, heel drops, or stomping, create vibrations in your bones that actually signal bone cells to make more bone. This is especially helpful in the hip area. 

Jumping just 10 to 20 times twice a day can improve hip bone density in premenopausal women. Jumping is not as effective in post-menopausal women but has been shown to positively affect hip bone density in some studies. 

People who cannot jump due to other conditions like knee pain or severe arthritis, can choose less intense options, like heel drops and stomping.

Balance training and agility. Balance is an important skill that can help reduce your risk of falls as you age. Practicing balancing on one leg, doing yoga, or even dancing are all ways to improve your balance.   

Similarly, agility exercises can reduce risk of falls and help maintain your fast twitch muscles, which can atrophy (waste away) as you age. Agility exercises can be simple to advanced, ranging from jumping jacks and jumping rope or using an agility ladder to complex plyometric exercises like box jumps and quick direction changes.  

Anti-inflammatory and bone health diet. It is important to get enough calcium, Vitamin D, magnesium, and Vitamin K in your diet. Requirements very with age, but in general:

• Most adults need 1,000 mg of calcium a day and 600 international units (IU) of Vitamin D per day.
• If you are over the age of 70, you need 1,200 mg of calcium and 800 IU of Vitamin D per day.  
• Adults should also try to get 400 mg of magnesium daily and 100 micrograms of Vitamin K daily.

An anti-inflammatory diet may help reduce joint pain and has also been associated with reduced fracture risk. Anti-inflammatory diets include:

• Lean proteins
• High fiber (goal 30 grams per day)
• Omega 3 fatty acids
• Colorful fruits and vegetables
• Limited saturated fats, processed foods, and extra sugar

Supplements. For people who do not get the recommended amounts of calcium, Vitamin D, magnesium, and Vitamin K2 through diet alone, supplements can be helpful.

There is also evidence that creatine monohydrate can help women build muscle mass with strength training, and this can secondarily benefit bone health. 

There is reasonable evidence that hydrolyzed collagen supplements can reduce knee pain and support bone health. 

Read an article co-authored by Dr. Vonda Wright, Dr. Jocelyn Wittstein, and colleagues about the musculoskeletal syndrome of menopause