What happens to bone collagen in menopause?

Written by: Dr Ilma Imtiaz

Midlife is a time of profound transition, and for many women, it’s when our skeletal health deserves our full attention. While osteoporosis and low bone mass affect nearly 54 million U.S. adults aged 50 and older [1] — with women accounting for over 80% of cases — the conversation often stops at calcium and bone mineral density. But true skeletal resilience is about more than density; it’s about the structural integrity of the collagen-rich protein matrix. 

As estrogen levels shift during menopause, this matrix can lose the support it needs to stay strong and flexible. Let’s explore how menopause contributes to osteoporosis, the role estrogen plays in bone collagen, and ways to support the body during this new chapter.

When does bone loss actually start?

Bone loss does not begin on the day menopause ends; in fact, at this point, it actually accelerates. That’s because peak bone mass is typically reached in your 20s or 30s, and bone loss can start gradually after that [2]. 

The rate of loss often accelerates during the menopause transition and early postmenopause, when hormonal shifts change bone turnover. That means bone health is built across decades, not just managed after menopause.

THE NUMBERS BEHIND MIDLIFE BONE LOSS

During the menopausal transition, women lose an average of around 10% of their bone mineral density (BMD). Some women may lose up to 20% within the 5–7 years surrounding menopause, and around one in four postmenopausal women are considered “fast bone losers,” [3] meaning they experience higher rates of bone breakdown after menopause.

Why is osteoporosis more common in postmenopausal women?

Osteoporosis is more common in women largely due to the sharp decline in estrogen during menopause [4]. Bone loss in postmenopausal women typically occurs in two phases: an initial rapid phase lasting around 3–5 years after menopause that mainly affects trabecular bone, followed by a slower age-related phase over the next 10–20 years involving both trabecular and cortical bone [3]. Together, these changes contribute to reduced bone strength and an increased risk of fragility fractures in postmenopausal women.

Why is estrogen associated with osteoporosis?

Estrogen plays an important role in maintaining healthy bone turnover balance by regulating bone-building cells (osteoblasts) and bone-breaking-down cells (osteoclasts), while also supporting collagen production within the bone matrix. Postmenopausal osteoporosis (PM-OP) begins with the decline in estrogen that occurs during menopause, which disrupts normal bone remodeling and leads to a state known as high bone turnover.

After menopause, bone breakdown increases by approximately 90%, while bone formation increases by only around 45%, resulting in a gradual net loss of bone with each remodeling cycle [3]. Because collagen forms the structural framework of bone, this accelerated turnover can also weaken the collagen-rich matrix that helps provide strength and flexibility to the skeleton.

BONE HEALTH 101: WHAT IS OSTEOPENIA?

Osteopenia is a condition where bone mineral density is lower than expected for healthy bones, which may make bones weaker and more fragile over time. However, the loss of bone density is not severe enough to be classified as osteoporosis. Osteopenia is commonly identified through a bone density scan, also known as a DEXA scan.

Why do DEXA scans not tell the full story about bone health?

Although BMD declines during menopause in all women, predicting who will develop osteoporosis or fracture is more complex. Many fractures in postmenopausal women actually occur in those with osteopenia, not osteoporosis, based on DEXA T-scores [2]. 

DEXA scans are considered the gold standard for measuring bone mineral density, but they mainly assess bone quantity rather than overall bone quality. Bone strength also depends on more than BMD alone — factors such as collagen integrity, bone microarchitecture and how well bone resists cracking under stress, which the DEXA scan does not capture [5].

What do DEXA scans miss about bone collagen and bone quality?

Because collagen forms the structural framework of bone, changes to the collagen-rich matrix during menopause may contribute to skeletal fragility in ways a DEXA scan cannot show [6]. This may help explain why some postmenopausal women experience fractures even when their BMD is not within the osteoporotic range, highlighting the importance of looking beyond scan results and considering broader structural and functional changes in bone during menopause.

What actually supports bone collagen after menopause

A practical bone-health strategy after menopause should look at the full picture: protein, vitamin C, vitamin D, vitamin K, magnesium, limiting alcohol and nicotine intake, and regular weight-bearing or resistance exercise. Together, these factors may help support normal collagen formation, bone remodeling and overall skeletal maintenance [7]. 

Lifestyle also matters. Low physical activity, smoking, poor nutrient intake and higher fall risk can all make bone health harder to maintain over time. In other words, bones respond to both what you eat and how you move.

Does collagen supplementation help postmenopausal bone health?

There is growing interest in specific collagen peptides and their role in postmenopausal bone health. Laboratory and animal studies suggest collagen peptides may help support the structural framework of bone, healthy bone remodeling and overall bone strength [7]. A recent scoping review also concluded that collagen supplementation shows promise in supporting bone metabolism and structure [8].

In a randomized controlled trial, 131 postmenopausal women with reduced bone mineral density who took 5 g per day of FORTIBONE bioactive collagen peptides showed improvements in BMD and bone turnover markers compared with placebo over 12 months [7]. 

A longer-term follow-up involving 31 women from the same cohort found that continued supplementation was associated with further BMD improvements after four years, suggesting bioactive collagen peptides may help support postmenopausal bone health as part of a broader bone-health routine [8].

Moving forward with confidence

While midlife brings inevitable shifts to our skeletal health, understanding the role of collagen reveals that we have more agency than we might realize. True resilience goes beyond simple density numbers — it’s about nurturing the structural framework that keeps us strong. 

By prioritizing targeted nutrition, including collagen that targets bone health, movement and a holistic view of bone health, we can actively support our body's adaptability and ensure our foundation remains as flexible and enduring as the life we’re living.

For women after menopause, this stage of life is an opportunity to take a broader approach to bone health, one that supports the structure, flexibility and resilience bones rely on every day.

Dr. Ilma Imtiaz has a background in biomedical and naturopathic research and recently completed her PhD at the National Centre for Naturopathic Medicine, Southern Cross University, Australia. She is a lead and co-author of multiple peer-reviewed publications, including experimental and review papers across herbal medicine, cancer biology and molecular mechanisms.

At the heart of her work is a passion for science communication, translating complex evidence into clear, engaging, and accessible insights. She is committed to evidence-led wellness and supporting informed, balanced health decisions.

References

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2. Jones, A.R., Bone health during the menopause: assessment and fracture prevention. Endocrinology Today, 2024: p. 21.
3. Eastell, R., et al., Postmenopausal osteoporosis. Nature reviews Disease primers, 2016. 2(1): p. 16069.
4. Yong, E.-L. and S. Logan, Menopausal osteoporosis: screening, prevention and treatment. Singapore medical journal, 2021. 62(4): p. 159.
5. Sangondimath, G., R.K. Sen, and F.R. T, DEXA and Imaging in Osteoporosis. Indian Journal of Orthopaedics, 2023. 57(1): p. 82-93.
6. Sornay-Rendu, E., F. Duboeuf, and R.D. Chapurlat, Postmenopausal women with normal BMD who have fractures have deteriorated bone microarchitecture: A prospective analysis from The OFELY study. Bone, 2024. 182: p. 117072.
7. König, D., et al., Specific Collagen Peptides Improve Bone Mineral Density and Bone Markers in Postmenopausal Women-A Randomized Controlled Study. Nutrients, 2018. 10(1).
8. Kuhlman, N.M., et al., The Role of Collagen Supplementation in Bone Metabolism and Structure: A Scoping Review. Clin J Sport Med, 2026.
9. Vigneswaran, K. and H. Hamoda, Hormone replacement therapy – Current recommendations. Best Practice & Research Clinical Obstetrics & Gynaecology, 2022. 81: p. 8-21.