Managing Perimenopause With Osteoporosis
Oestrogen protects bone density. Learn how to manage osteoporosis through perimenopause and reduce your fracture risk long term.
Bone Density and the Perimenopausal Shift
Oestrogen is one of the most important hormones for maintaining bone density throughout a woman's adult life. It slows the rate at which bone is broken down, helping to keep the natural balance between bone resorption and bone formation in equilibrium. During perimenopause, as oestrogen levels become erratic and then progressively fall, this protective effect weakens. Bone loss can accelerate significantly in the years immediately surrounding the menopause transition, sometimes reaching two to three percent per year at its fastest. For women who already have osteoporosis or osteopenia, this phase can meaningfully increase fracture risk if it is not actively monitored and managed.
Understanding Your Bone Density Results
Osteoporosis is diagnosed through a DEXA scan, which measures bone mineral density at the hip and spine and expresses the result as a T-score. A T-score between -1 and -2.5 indicates osteopenia (reduced bone density), while -2.5 or below indicates osteoporosis. These numbers provide a useful baseline, but they are not the whole story. Other factors including age, height, weight, family history, smoking status, alcohol intake, steroid use, and previous fractures feed into your overall fracture risk score, known as FRAX. Understanding your FRAX score, not just your T-score, helps your doctor advise on which interventions are most appropriate for your individual situation.
Calcium, Vitamin D, and Bone-Supporting Nutrition
Calcium and vitamin D remain the nutritional foundation of bone health throughout life. Most adults need between 700 and 1,200 milligrams of calcium daily, ideally from food sources such as dairy products, fortified plant milks, leafy green vegetables, and tinned fish with bones. Vitamin D is essential for calcium absorption, and because many people, particularly in northern latitudes or those spending little time outdoors, are deficient, supplementation of 1,000 to 2,000 IU daily is commonly recommended. Adequate protein intake also supports bone matrix quality and the muscle strength that protects against falls. Magnesium, vitamin K2, and zinc all play supporting roles and are best obtained through a varied diet.
Exercise That Builds and Protects Bone
Weight-bearing and resistance exercises are the most effective forms of physical activity for stimulating bone formation and maintaining bone density. Walking, jogging, dancing, hiking on varied terrain, and strength training all qualify as weight-bearing activity. Resistance training using weights, machines, or resistance bands provides additional mechanical loading that prompts bone to adapt and strengthen. Balance and coordination exercises, such as tai chi, yoga, or single-leg standing, reduce the risk of falls, which represents the most direct route to fracture in women with osteoporosis. A combination of all three exercise types, done consistently across the week, provides the broadest protection and also benefits mood, energy, and cardiovascular health.
Medications for Osteoporosis During Perimenopause
Several medications are used to treat osteoporosis, with bisphosphonates such as alendronate being the most widely prescribed first-line option. These drugs slow bone breakdown and can reduce fracture risk significantly over a three to five year course. HRT is another treatment specifically relevant to perimenopausal women, since replacing oestrogen directly addresses the hormonal mechanism driving accelerated bone loss during this phase. For women whose bone health is a primary concern alongside significant perimenopausal symptoms, HRT can offer dual benefit and is worth discussing explicitly with a GP or menopause specialist. The decision depends on individual risk factors, symptom burden, and informed personal preference.
Fall Prevention as a Core Priority
For women living with osteoporosis, avoiding a fall is as clinically important as protecting bone density, because a fall with compromised bones can cause fractures at the hip, spine, or wrist with serious consequences for mobility and independence. Practical fall prevention covers a range of areas: checking that your home is free of trip hazards such as loose rugs or poor lighting, wearing supportive well-fitting footwear, keeping corridors and bathrooms well lit, and addressing any medication side effects, vision problems, or balance issues that increase instability. Muscle strength and balance training directly improve both reaction speed and postural control, making resistance exercise doubly valuable.
Monitoring Progress and Staying Proactive
Repeat DEXA scans are typically recommended every two to three years to assess whether bone density is stable, improving, or continuing to decline. Tracking your symptoms, activity levels, and diet alongside your scan results helps you have more informed and productive conversations with your healthcare team. If you log your workouts consistently, you build a record of the specific work you are doing to protect your bones, which can be encouraging during what can feel like a slow and invisible process. The perimenopausal years can be demanding, but the actions taken now to build and maintain bone health have direct and lasting consequences for quality of life in your 60s, 70s, and beyond.
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