Deep Dive: Bone Health in Perimenopause
- Kristyn Zalota
- Apr 9
- 2 min read
Updated: Apr 15
Women die from hip fractures?
Yes! Worldwide, 1 in 3 women over age 50 will experience osteoporosis fractures. After a hip fracture, women experienced mortality rates up to 20-24% in the first year after the fracture, with another 33% are left totally dependent for at least a year!
The risk of death from a hip fracture in a 50-year-old White woman in the United States is 2.8% for the remainder of her life, which is equivalent to the risk of death from breast cancer.[i]
Why does bone loss occur in perimenopause?
In a word: estrogen.
In a continuous process known as remodeling, old bone tissue is steadily broken down by specialized cells called osteoclasts, while another type of cell (osteoblasts) works to build new bone in its place. Estrogen is central to keeping these two forces in balance.
During perimenopause and menopause, falling estrogen levels tip this balance toward breakdown. Bone is lost faster than it can be replaced, and this accelerated loss is most pronounced in the decade following the last menstrual period. After that window, the pace slows
but the loss doesn't stop.
For women who experience early or premature menopause, this process begins sooner, giving the skeleton less time to maintain its density before decline sets in. Over the long term, this translates to a higher risk of low bone density and fractures..[ii]
What to do for your bones in perimenopause?
Strengthen and move. According to the Royal Osteoporisis Society [iii] people with sedentary lifestyle are more likely to have a hip fracture than those who are more active.
Women in perimenopause are advised to:
do weight-bearing impact exercise (50 jumps, 30 mn/day of running, dancing, tennis) and muscle-strengthening exercise (2 -3 times/week, 20-30mn)
eat a well balanced diet - avoid under-nutrition, especially severe weight-loss diets
get at least 1,200 mg/day of calcium, 400-600 IU of vitamin D forcalcium absorption (diet or supplements)
take Vitamins B,C,K and magnesium
quit smoking or vaping, avoid alcohol consumption
Can HRT help?
Yes! Clinical studies have shown that any form of hormone replacement therapy can reduce bone turnover, decrease bone resorption, enhance bone mineral density and reduce vertebral and hip fractures.[iv]
The combination of HRT and structured exercise offers the most effective approach for increasing bone mass density in menopausal women. [v]
Despite the overwhelming evidence that HRT has a positive effect on bone health, HRT is not prescribed to promote bone health for women without menopause symptoms, even if they are risk. [vi]
If you are at risk, talk to your doctor about testing and treatments, including hormone replacement therapy (HRT).
Read on about Heart Health in perimenopause.
[iv] Levy et al
[vi] Harper-Harrison G, Carlson K, Shanahan MM. Hormone Replacement Therapy. 2024 Oct 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 29630243.
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