Women should pay closer attention to their bone health as they approach menopause, when falling oestrogen levels can accelerate bone loss and increase the risk of fractures later in life.
Dr Jocelyn Wittstein, an orthopaedic surgeon at Duke Health in North Carolina, told NBC News that bone loss can accelerate around two years before menopause, which occurs at an average age of 51 in the US.
Women can lose around 10 percent of their bone density over the period surrounding menopause, she said.
Osteoporosis is often called a "silent disease" because it usually causes no noticeable symptoms until a bone breaks. However, Wittstein identified four possible signs of weakened bones that women should not overlook.
Four Signs to Watch For
Fractures After Minor Falls
A broken wrist, hip or other bone following a relatively minor fall can indicate reduced bone density.
Wittstein said a wrist fracture in a woman in her 50s should prompt consideration of a bone density assessment.
Routine osteoporosis screening is generally recommended for women aged 65 and older, and earlier for postmenopausal women with certain risk factors.
Persistent Pain During Exercise
Ongoing pain in the hip or heel during activities such as running should not be ignored, Wittstein said.
Although such pain does not necessarily indicate osteoporosis, it can sometimes be associated with a stress fracture or another injury requiring medical assessment.
Loss of Height
A noticeable reduction in height can result from compression fractures in the spine, which may occur when weakened vertebrae collapse.
Such fractures can develop without a major injury and may be a sign of osteoporosis.
Changes in Posture
A stooped or increasingly hunched back can also indicate vertebral compression fractures.
Wittstein said some people discover they have osteoporosis only after an everyday movement, such as lifting an object, leads to a fracture.
How to Protect Bone Health
Wittstein recommends a combination of nutrition and regular exercise to help slow bone loss.
Women over 50 need about 1,200 mg of calcium and 800 IU of vitamin D daily, with calcium preferably from food. Magnesium and fibre also support bone health.
Resistance training and brisk walking can help maintain bone density, while menopausal hormone therapy may strengthen bones and prevent fractures in suitable patients, Wittstein says.
For those who cannot or choose not to use hormone therapy, she says diet and exercise remain essential to protecting bone health.