Understanding Bone Loss Around Menopause: Why These Years Matter Most
For many women, the menopause transition brings noticeable physical changes, but one of the most important (and least visible) changes happens within the bones.
Research shows that the years surrounding the final menstrual period are a critical window where bone mineral density (BMD) declines more rapidly than at any other stage of adult life.
Understanding this process helps women make informed, proactive decisions about their long-term bone health.
Why Does Bone Loss Accelerate During Menopause?
Oestrogen plays a key role in regulating bone turnover. As levels drop during late perimenopause and the early postmenopausal years, the balance shifts toward greater bone breakdown than bone formation.
A large longitudinal study of 1,902 women (Finkelstein et al., 2008) provides clear evidence of how quickly this change can occur.
Bone Loss Across the Lifespan: What’s Normal?
In typical ageing outside the menopause transition, bone loss occurs slowly:
Pre-menopause: bone mass is largely stable
General ageing 50+: approximately 0.3–0.5% per year
This baseline helps illustrate why the menopause years represent a distinct period of faster bone change.
How Much Bone Is Typically Lost Around Menopause?
Late Perimenopause (1–2 years before the final period)
Lumbar spine: ~1.8% loss per year
Hip: ~1.0% loss per year
Early Postmenopause (3–5 years after the final period)
Lumbar spine: ~2.2% loss per year
Hip: ~1.3% loss per year
In practical terms, many women experience:
~2% bone loss per year at the spine
~1–1.5% bone loss per year at the hip
Although these numbers might not seem large, over a span of five years this can amount to 5–10% loss of bone mineral density.
Why These Changes Matter: Understanding Standard Deviations
Bone density results are often described using standard deviations (SD).
This is a statistical way of showing how far someone’s bone density is from what is typical for a healthy young adult.
Here’s the key relationship:
A drop of one standard deviation (1 SD) is associated with roughly double the risk of a fracture.
As we’ve seen above, during the menopause transition many women lose 5–10% of bone density, particularly at the spine. Even though the yearly decline seems small, these losses accumulate and move a woman closer to the 1 SD point where fracture risk rises (doubles!).
This helps put the numbers into context: the concern is not only that bone density decreases — it’s that the decline shifts a woman into a higher-risk range, often long before her first bone density scan.
The Role of Body Weight and Muscle Mass
The study by Finkelstein et al., 2008, showed that some women lose bone more rapidly than others. They found that women with higher body weight lost bone 35–55% more slowly than lighter women. Although the exact reason for this is unknown, one possibility is that there is more mechanical loading on the skeleton. This highlights the importance of mechanical loading and exercise in slowing bone loss.
What This Means for Women in Their 40s and 50s
1. The menopause transition is a key window for bone health
Bone loss accelerates sharply before and after the final menstrual period, then gradually stabilises.
2. Exercise is one of the most effective tools available
Weight-bearing, resistance and impact-based exercise can help slow or partially offset menopausal bone loss
(Watson et al., 2018; Guadalupe-Grau et al., 2009).
3. Nutrition supports bone turnover
Adequate calcium, vitamin D, and sufficient protein all contribute to healthy bone metabolism.
4. Early awareness encourages early action
Many women only discover reduced BMD once a DXA scan is performed in their 60s — but the most rapid changes occur 10–15 years earlier.
How We Support Bone Health at Balanced Physiotherapy & Pilates
At Balanced Physiotherapy & Pilates in Vincentia, we help women build strong, adaptable bone through:
Physiotherapist-led strength training and Pilates
Tailored home exercise programs
Education on bone health and menopause
Strategies to maintain muscle mass through midlife
Collaboration with GPs for screening and DXA referral when appropriate
Our goal is to support women with clear information and evidence-based movement during the years when proactive steps make the greatest difference.
References
Finkelstein, J. S., Brockwell, S. E., Mehta, V., Greendale, G. A., Sowers, M. R., Ettinger, B., Lo, J. C., Johnston, J. M., Cauley, J. A., Danielson, M. E., & Neer, R. M. (2008). Bone mineral density changes during the menopause transition in a multiethnic cohort of women. Journal of Clinical Endocrinology & Metabolism, 93(3), 861–868.
https://doi.org/10.1210/jc.2007-1876
Guadalupe-Grau, A., Fuentes, T., Guerra, B., & Calbet, J. A. L. (2009). Exercise and bone mass in adults. Sports Medicine, 39(6), 439–468.
https://doi.org/10.2165/00007256-200939060-00002
Looker, A. C., Borrud, L. G., Dawson-Hughes, B., Shepherd, J. A., & Wright, N. C. (2012). Osteoporosis or low bone mass at the femur neck or lumbar spine in older adults: United States, 2005–2008. NCHS Data Brief, (93), 1–8.
Marshall, D., Johnell, O., & Wedel, H. (1996). Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ, 312(7041), 1254–1259.
https://doi.org/10.1136/bmj.312.7041.1254
Riggs, B. L., Melton, L. J., Robb, R. A., Camp, J. J., Atkinson, E. J., Oberg, A. L., Rouleau, P. A., McCollough, C. H., & Khosla, S. (2008). Population-based study of age and sex differences in bone volumetric density, size, geometry, and structure at different skeletal sites. Journal of Bone and Mineral Research, 23(12), 1945–1954.
https://doi.org/10.1359/jbmr.080810
Watson, S. L., Weeks, B. K., Weis, L. J., Harding, A. T., Horan, S. A., Beck, B. R. (2018). High-intensity resistance and impact training improves bone mineral density in postmenopausal women with low bone mass: The LIFTMOR randomized controlled trial. Journal of Bone and Mineral Research, 33(2), 211–220.
https://doi.org/10.1002/jbmr.3284