Protecting Your Bones: A Comprehensive Guide for Women in Perimenopause and Menopause

"Estrogen plays an important role in maintaining bone and decreasing fracture risk. With the onset of menopause, a woman’s risk of osteoporosis increases and 1 in 3 women over the age of 50 will experience a fracture due to osteoporosis in their lifetime." (Osteoporosis Canada, 2026)

Understanding Bone Density Changes in Midlife

As women progress through perimenopause and menopause, bone health becomes a critical area of focus. The hormonal transitions during this period significantly impact bone metabolism, creating a crucial window for proactive health management. 

Menopause significantly speeds bone loss and increases the risk of osteoporosis. Research indicates that up to 20% of bone loss can happen during these stages.

Approximately 1 in 10 women over the age of 60 are affected by osteoporosis worldwide.  

One in two postmenopausal women will have osteoporosis, and most will suffer a fracture during their lifetime.

"An accelerated rate of bone loss occurs during the menopausal transition, with the greatest reduction occurring in the year before the final menstrual period and the first 2 years thereafter." (Lo, et al. 2011)

The Hormonal Influence on Bone Density

Estrogen plays a pivotal role in bone health. When estrogen levels decline, bone remodelling becomes imbalanced. The rate of bone breakdown (osteoclast cells "cleave" bone or resorb bone) begins to outpace bone formation (osteoblast cells "build bone"), increasing the risk of osteoporosis and fractures.

1. Calcium Intake Assessment

Accurate calcium consumption is fundamental to bone health. The Osteoporosis Canada Calcium Calculator is an essential tool I tell all my patients to use to evaluate their daily calcium intake from food. 

- Prioritize dietary calcium sources before supplementation

- Recommended daily intake of calcium: 1000-1200 mg

- Optimal sources include dairy products, leafy greens, beans, lentils, tofu, fish, nuts, etc.

- Supplement only when dietary intake is insufficient

2. Vitamin D Optimization

Critical for calcium absorption and bone health:

- Requires comprehensive serum blood testing

- Dosage personalized based on individual test results

- Typical supplementation ranges from 1000-4000 IU daily

- Crucial for maintaining bone mineral density

3. Vitamin K2 Supplementation

Precision is key in vitamin K2 supplementation:

- Recommended dosage: One capsule daily

- Supports calcium metabolism

- Enhances calcium absorption in the body

- Works synergistically with Vitamin D

4. Resistance Training

A critical intervention for maintaining bone density is key for all women. Regular weight-bearing exercises & strength training. A minimum of 2-3 sessions of resistance training weekly. Daily is even better. Consider using multiple resistance modalities (weights, resistance bands, bodyweight exercises, using a weighted vest).

Supplement Strategy Guidance

Vitamin D3 supplementation requires careful approach specific to your individual requirements. I recommend annual testing of 25-hydroxy-Vitamin D3 levels to optimize your levels. Ideally you want to be in the mid range of the normal value in blood range values.

For example if a person requires: 4000 IU Vitamin D3 requirement, then I suggest taking 3 drops of Vitamin D3 (3000 IU total) plus an additional 1 capsule of combined K2-D3 supplement. 

I suggest avoiding excessive supplementation, and rather to maintain a balanced, targeted approach based on blood testing.

Consideration in some women is to use a creatine monohydrate powder daily 5 grams of powder mixed in a protein shake daily to meet protein target goals as well as support muscle and bone health.

Important markers and warning signs:

- Decreased height

- Changes in posture

- Family history of osteoporosis

- Petite body frame or stature, or a body weight <100lbs

- Increased fracture risk or history of fractures

- Long term use of corticosteroids such as prednisone

- Measurable bone density changes

Every individual's bone health journey is unique. Factors including:

- Genetic predisposition (Did your parent or grand parent have osteoporosis? And what age?)

- Nutritional status (Do you eat a well balanced diet and are you getting enough calcium based on the calcium calculator?)

- Physical activity level (Do you do resistance training on a regular basis?)

- Hormonal changes (Are you perimenopausal or menopausal?)

 Conclusion

The time to think about your bone health is in your 30's, 40's and 50's. Be proactive in the management of your bone health, as this is a critical aspect of women's wellness during perimenopause and menopause.

Understanding the complex interplay of hormones, nutrition, and physical activity empowers women to maintain bone strength and overall health. Dietary calcium however is the best absorption compared to supplemental form. So I always say start with diet and then go from there if needed.

Interested in learning more about and working with Dr. Amy? If so, book a free discovery call here.

To your health,

Dr. Amy Tung, ND, MSCP

Menopause Society Certified Practitioner

*Disclaimer: This information is for educational purposes. Always consult with a healthcare professional for personalized medical advice.*

References:

Chapurlat, R., Garnero, P., Sornay‐Rendu, E., Arlot, M., Claustrat, B., & Delmas, P. (2000). Longitudinal Study of Bone Loss in Pre- and Perimenopausal Women: Evidence for Bone Loss in Perimenopausal Women . Osteoporosis International, 11, 493-498. https://doi.org/10.1007/s001980070091.

Elders, P., Netelenbos, J., Lips, P., Ginkel, F., Khoe, E., Leeuwenkamp, O., Hackeng, W., & Stelt, P. (1991). Calcium supplementation reduces vertebral bone loss in perimenopausal women: a controlled trial in 248 women between 46 and 55 years of age.. The Journal of clinical endocrinology and metabolism, 73 3, 533-40 . https://doi.org/10.1210/JCEM-73-3-533.

Endocrine Society. Menopause & Bone Loss. https://www.endocrine.org/patient-engagement/endocrine-library/menopause-and-bone-loss

Lo, J., Burnett-Bowie, S., & Finkelstein, J. (2011). Bone and the perimenopause.. Obstetrics and gynecology clinics of North America, 38 3, 503-17 . https://doi.org/10.1016/j.ogc.2011.07.001.

Osteoporosis Canada Calcium Calculator: https://osteoporosis.ca/calcium-calculator/

Shieh, A., Greendale, G., Cauley, J., Karvonen-Gutierrez, C., Crandall, C., & Karlamangla, A. (2019). Estradiol and Follicle‐Stimulating Hormone as Predictors of Onset of Menopause Transition‐Related Bone Loss in Pre‐ and Perimenopausal Women. Journal of Bone and Mineral Research, 34. https://doi.org/10.1002/jbmr.3856.