Bone health usually isn’t the first thing we think of when we hear perimenopause or menopause. Mood swings and brain fog hog the spotlight (among other symptoms!), while your skeleton quietly loses strength in the background. But here’s the thing: for many women, the biggest long-term health impact of perimenopause and menopause is what happens to your bones, muscles, and joints. Orthopedic surgeon and leading menopause expert Dr. Vonda Wright calls this health impact the “musculoskeletal syndrome of menopause”, a cluster of bone loss, muscle loss, joint pain, and higher fracture risk that is just as common as hot flashes and can wreak even more havoc if we ignore it.
The good news? There is so much you can do, starting today, to protect your bones and stay strong. These 4 menopause podcast episodes and blog on bone health walk you through what’s happening, why it matters, and the most evidence-based actions you can take in perimenopause and beyond. Looking for more podcasts on bone health? We’ve got you covered here.
Key takeaways on bone health in perimenopause & menopause
- Estrogen is a bone-protective hormone. When it drops in perimenopause and menopause, bone loss accelerates and fracture risk rises.
- Women lose roughly 10–12% of their bone density in the years around their final period, and about 30% between ages 50 and 80 on average.
- Osteoporosis is common: up to 1 in 3 women over 50 will experience an osteoporotic fracture in their lifetime.
- Perimenopause is a critical window: what you do now with movement, nutrition, and treatment can dramatically change your future fracture risk.
- Weight-bearing and resistance exercise, adequate calcium and vitamin D, and not smoking are foundational; they’re strongly supported by international guidelines.
- Hormone therapy and other medications can be powerful tools for women at higher risk and are endorsed by major societies when used appropriately.
- Dr. Vonda Wright emphasizes that bone and muscle health start decades before menopause, but it’s never too late to get stronger.
What’s actually happening to your bones?
Your skeleton is not a fixed structure, it’s living tissue. Bone is constantly being broken down by cells called osteoclasts and rebuilt by osteoblasts. In youth, building wins. By mid-30s, breakdown slowly starts to gain ground.
When estrogen levels fall in perimenopause and menopause, that balance tips further:
- Bone breakdown speeds up.
- Bone building slows down.
- The inner “scaffolding” of bone becomes thinner and more fragile.
A 2024 review on menopause and bone health highlighted that estrogen loss after menopause is a key driver of decreased bone strength and higher osteoporosis risk. That’s why major organizations like The Menopause Society (formerly NAMS), the Endocrine Society, and national osteoporosis groups all flag midlife as the turning point for bone health.
Dr. Vonda Wright’s message: perimenopause is a musculoskeletal turning point
Dr. Vonda Wright, an orthopedic surgeon and leading expert in healthy aging, has helped put bone and muscle at the center of the menopause conversation. She describes:
- A “musculoskeletal syndrome of menopause” as joint pain, cartilage changes, loss of muscle mass, and bone loss that many women experience around midlife.
- The idea that frailty is not inevitable; it’s often the result of disuse and unaddressed bone and muscle loss, not just age.
- The importance of “loading the skeleton” – using strength and impact (safely) to stimulate bones to stay dense and strong.
- Prevention that starts decades earlier, ideally in our 20s and 30s… but with meaningful gains still possible in our 40s, 50s, 60s and beyond.
Her core philosophy: you are not fragile by default. With the right movement, fuel, and medical support when needed, you can stay powerful well into later life. Thank you, Dr. Vonda Wright, for leading the way on this topic!
Are you and your bones at higher risk?
Guidelines suggest paying extra attention to bone health if any of these apply:
- Early menopause (before 45) or primary ovarian insufficiency
- Family history of hip or vertebral fracture
- Previous low-trauma fracture (e.g. breaking a wrist from a simple fall)
- Very low body weight or significant weight loss
- Smoking or high alcohol intake
- Long-term use of steroids or certain other medications
- Conditions like rheumatoid arthritis, celiac disease, inflammatory bowel disease, or eating disorders
If you see yourself in this list, it’s a strong nudge to talk with your clinician about getting a bone density scan (DXA) and a formal fracture risk assessment (often using tools like FRAX).
What you can do: 6 evidence-backed strategies for stronger bones
1. Move like your bones depend on it (because they do!)
International guidelines consistently highlight regular weight-bearing and muscle-strengthening exercise as a cornerstone of osteoporosis prevention and management.
Helpful exercise patterns include:
- Weight-bearing cardio: brisk walking, hiking, stair climbing, low-impact jogging (if joints allow), dancing.
- Resistance training: 2–3 sessions per week using weights, resistance bands, or bodyweight (squats, lunges, push-ups, rows).
- Balance and mobility work: yoga, tai chi, single-leg exercises to reduce falls.
A 2023 position statement on exercise for osteoporosis found that regular resistance and weight-bearing exercise can preserve or increase bone mineral density and lower fall risk in midlife and older adults.
Dr. Wright’s take aligns, and she emphasizes lifting, loading, and moving with intention as essential tools to “age strong.”
If you’re new to strength training or have osteoporosis, ask a physiotherapist or trainer with bone health experience to help you start safely.
2. Feed your skeleton: calcium, vitamin D & protein
Bones are living tissue. They need building blocks.
Calcium
- Most guidelines recommend around 1,000–1,200 mg of calcium per day for midlife women, ideally from food first (dairy, fortified plant milks, tofu set with calcium, leafy greens, canned fish with bones, nuts).
- If you don’t reach that through food, a supplement may help – but talk to your clinician, especially if you have kidney or heart issues.
Vitamin D
- Vitamin D helps your gut absorb calcium and supports muscle function.
- A daily intake of around 600–800 IU (15–20 micrograms) of vitamin D is commonly recommended for women in perimenopause, as this is the standard guideline for adults over 50 and supports the increased bone needs that begin during this stage.
- Depending on your location, skin tone, sun exposure, and diet, you may need a supplement; blood testing can clarify this.
Protein
- Protein supports both bone and muscle.
- Reviews on women’s bone health recommend adequate daily protein (often ~1.0–1.2 grams per kg of weight per day for older adults) alongside resistance training to support bone density and reduce frailty.
Ask your healthcare provider if you have any questions on these building blocks!
3. Address smoking, alcohol, and falls
Lifestyle isn’t everything, but it does matter.
- Smoking speeds bone loss and is consistently linked to higher fracture risk; stopping is one of the best gifts you can give your future self.
- Alcohol: heavy drinking weakens bones and increases falls; guidelines generally advise keeping intake moderate or low.
- Fall-proof your environment: good lighting, fewer trip hazards, supportive shoes, and addressing vision issues all help, because falls are how many fractures actually happen.
4. Talk about hormone replacement therapy (HRT) and other medications
This is where it gets more individual.
The 2022 hormone therapy position statement from The Menopause Society confirms that HRT:
- Can prevent bone loss and lowers fracture risk while you’re taking it
- Is an appropriate first-line option for healthy women under 60 or within 10 years of menopause, especially if they have symptoms and/or higher fracture risk
- Is particularly important for women with early or premature menopause, who have more years of estrogen deficiency
This is not one-size-fits-all. If you’re wondering about HRT or bone medications, bring your history, risk factors, and questions to a perimenopause and menopause-informed clinician or bone health specialist.
5. Get your numbers: bone health scans & scores
Rather than guessing, use data. Guidelines generally suggest considering a bone density scan (DXA) for:
- Women 65+
- Younger postmenopausal women (and some perimenopausal) with risk factors or prior fractures
DXA gives you a T-score, which helps classify bone density:
- Normal: T-score above -1.0
- Osteopenia (low bone density): between -1.0 and -2.5
- Osteoporosis: -2.5 or lower
Tools like FRAX combine your age, bone density (if available), and risk factors to estimate your 10-year fracture risk and guide decisions about treatment. Ask your healthcare provider whether you can get these tests done, so you know!
6. Don’t forget the emotional side of bone health
Learning that you have low bone density or osteoporosis can feel frightening or like your body has let you down. It hasn’t. Things that may help you:
- Education – try to understand what’s happening to make it less scary and more actionable (hence these 4 podcast picks and blog as a start!)
- Community – join online or in-person groups focused on menopause or bone health can reduce isolation, or just talk to your friends about it.
- Reframing movement – move from viewing exercise as a punishment or only for looks to building a stronger future self; strong is the goal, not thin.
- Professional support – seek out support from a perimenopause or menopause healthcare specialist in your region, an orthopedic surgeon, physiotherapist, strength coach, or psychologist familiar with bone health.
As Dr. Wright and other experts in healthy aging keep stressing, strength is a skill you can train, not a personality trait you either have or don’t.
What NOT to do for your bones
- Don’t assume bone loss is “just aging” and can’t be changed. Treatment and lifestyle changes do reduce fractures.
- Don’t crash diet or severely under-eat. Low energy intake and low body weight are both bad for bones.
- Don’t avoid all impact or strength work out of fear, unless your clinician has specifically told you to; the right kind of load is often exactly what bones need.
- Don’t self-start supplements or medications without checking interactions and your personal risk profile.
Supporting yourself through this critical life phase
Perimenopause and menopause can feel like a lot – hormones shifting, sleep changes, mood changes, and now you’re told to think about bone density too. Some ideas for making it realistic:
- Stack habits: add a 10-minute walk after lunch, do 2 sets of squats, or 20 jumping jacks, while the kettle boils.
- Think “future me”: picture yourself in 20 years, climbing stairs confidently, traveling, playing with grandchildren or nieces/nephews. Your choices now are a direct love letter to her.
- Team up: exercise with a friend, partner, or group class; it’s easier (and more fun) to stay consistent.
- Ask for bone-specific help: many clinics now run fracture liaison or bone health services that coordinate scans, lifestyle support, and medications.
Final thoughts: Your bones are listening
Perimenopause and menopause mark a biological turning point, but not a cliff (or wall, depending on how you want to see it).
Your bones are constantly listening to the signals you send: movement, food, hormones, and medications when indicated. With curiosity, information, and steady action, you can move through midlife not just hoping to avoid fractures, but actively stacking the odds in your favor.
Dr. Vonda Wright and many other experts are clear: strong bones and muscles aren’t about chasing youth; they’re about protecting your independence, joy, and vitality for decades to come.
As always, if you’re concerned about your bone health in perimenopause or post-menopause, talk with your healthcare provider about bone density testing, lifestyle changes, and whether hormone therapy or osteoporosis medications are right for you.
Sources
de Villiers TJ. Bone health and menopause: Osteoporosis prevention and treatment. https://www.sciencedirect.com/science/article/abs/pii/S1521690X23000568
The North American Menopause Society (NAMS). Management of osteoporosis in postmenopausal women: the 2021 position statement. https://menopause.org/wp-content/uploads/professional/2021-osteoporosis-position-statement_577e5813-cdfa-4d5f-a7f2-3c3f3ec0e4c9.pdf
Endocrine Society. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Clinical Practice Guideline. https://pubmed.ncbi.nlm.nih.gov/30907953/
National Osteoporosis Guideline Group (NOGG). Clinical guideline for the prevention and treatment of osteoporosis. 2024. https://www.nogg.org.uk/sites/nogg/download/NOGG-Guideline-2024.pdf
NAMS. 2022 Hormone Therapy Position Statement. 2022. https://menopause.org/professional-resources/position-statements
British Menopause Society (BMS). Prevention and Treatment of Osteoporosis in Postmenopausal Women. 2025 update. https://thebms.org.uk/wp-content/uploads/2023/10/06-BMS-ConsensusStatement-Prevention-and-treatment-of-osteoporosis-in-women-SEPT2023-A.pdf
Vonda J. Wright, et al. The Musculoskeletal Syndrome of Menopause. Climacteric. 2024. https://pubmed.ncbi.nlm.nih.gov/39077777/
“How Menopause Impacts Bones, Muscles, and Joints.” Oprah Daily. 2025. https://www.oprahdaily.com/life/health/a65887608/menopause-bone-muscle-joint-pain/
The Pause Blog. “Aging Strong: What We Learned From Dr. Vonda Wright on Preventing Frailty, Osteoporosis, and Muscle Loss.” https://thepauselife.com/blogs/the-pause-blog/aging-strong-what-we-learned-from-dr-vonda-wright-on-preventing-frailty-osteoporosis-and-muscle-loss
American Academy of Orthopaedic Surgeons (AAOS). Strong Bones, Stronger You: Essential Tips for Women in Menopause. 2024. https://elsevier.health/en-US/preview/reproductive-health/postmenopausal-osteoporosis-clinical-overview
Healthy Bones Australia. Position Statement on Osteoporosis. 2023. https://healthybonesaustralia.org.au/wp-content/uploads/2023/02/position-statement-on-osteoporosis-february-2023.pdf
“Why the Menopause Set Is Obsessed With Weighted Vests.” Allure, Feb 11 2025. https://www.allure.com/story/menopause-weighted-vests allure.com
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