The Hidden Fracture | Why menopausal bone loss starts earlier than we think – and what we’re missing

Osteoporosis is one of Australia’s most under-recognised chronic diseases, yet its impact rivals cardiovascular disease in scale. New data from Healthy Bones Australia shows 6.2 million Australians over 50 already have poor bone health - and most aren’t screened until their 60s or after a fracture.¹

For women, bone loss begins up to a decade before menopause. Gradual hormonal shifts, low-grade inflammation, and nutrient insufficiencies silently erode bone strength.^2-4 Understanding this early cascade allows healthcare professionals to move from reactive treatment to proactive prevention, supporting skeletal resilience through early education, targeted nutrition, and integrative care.

A silent epidemic hiding in plain sight

Osteoporosis affects more Australians over 50 than heart disease or diabetes. Healthy Bones Australia (2023) reports that 6.2 million Australians - almost two-thirds of those aged 50 and older - already have poor bone health, a 34 percent increase since 2012. Of these, 77 percent have osteopenia and 23 percent osteoporosis. Without urgent intervention, that number is projected to rise 23 percent by 2033.¹

Despite this enormous burden, osteoporosis remains under-diagnosed and under-treated. Its earliest changes often go unnoticed, leaving practitioners to intervene only after bone failure.⁵

Alarmingly, bone loss can begin up to a decade before menopause during the perimenopausal years, driven by gradual oestrogen decline, low-grade inflammation, and nutrient insufficiencies that erode bone strength long before diagnosis.^3,6 The result is a preventable epidemic: an estimated 2.1 million fractures over the next decade, costing $67.9 billion and claiming more than 5,000 lives each year.^1,7 These data demand a shift - from reactive fracture management to proactive prevention during perimenopause, where early nutrition, lifestyle, and integrative care can preserve skeletal resilience.