Perimenopausal Bone Loss

Did you know? Bone loss accelerates dramatically before menopause even occurs! In the 2 years before the final menstrual period, a woman loses roughly 1/3 of total amount of bone lost in the first 5 years after menopause, when bone loss is most rapid. Simply stated, by the time menopause is reached, bone strength has already diminished. This is important information, particularly for women at high risk for osteoporosis as it highlights the value of early assessment and timely prevention strategies.

Who is at risk? Risk factors for osteoporosis include:

• Non-Modifiable Factors:

  • Older age (strongest predictor)

  • Menopause before age 40 years

  • Having a parent who had a hip fracture

• Modifiable Lifestyle Factors:

  • Low body weight (<127 lb or <58 kg) and low BMI (<20)

  • Risky Substances: current smoking, excessive alcohol consumption (≥3 drinks daily),

  • Nutrition: vitamin D deficiency, low calcium intake

  • Physical Activity: immobilization

  • Prior fractures or falls

• Medical Conditions and Medications:

  • Inflammatory conditions: rheumatoid arthritis, inflammatory bowel disease

  • Endocrine disorders: premature menopause (<40 years), hyperthyroidism, etc

  • Chronic diseases: chronic kidney and/or liver disease, inflammatory bowel disease, rheumatoid arthritis

  • Medications including prednisone, some anticonvulsants, anticoagulants, and some medications used in treatments of breast and other hormone sensitive cancers.

What can we do? Current clinical guidelines recommend a baseline bone density scan after menopause for the majority of women. However, for women at increased risk, initiating osteoporosis prevention during perimenopause or early menopause can be highly effective in preventing bone loss and preserving the underlying bone architecture that supports long-term skeletal strength.

Several evidence-based therapies are available and demonstrate comparable efficacy in protecting bone health, including hormone therapy and bisphosphonates. For women who are also experiencing menopausal symptoms that are treatable with hormone therapy, early initiation may offer dual benefits—relieving symptoms while simultaneously protecting bone density. Ultimately, proactive treatment during the menopausal transition can meaningfully improve future bone health and overall well-being.

Knowledge is power! Knowledge is power. Partnering with your physician or a menopause specialist can help you understand your individual risk factors and treatment options, allowing you to make informed decisions that support both your current health and long-term well-being.