How Do I Actually Protect My Bones in Perimenopause?

Why Bone Loss Speeds Up in Perimenopause

Oestrogen is not just a reproductive hormone. It is also one of the main brakes on bone breakdown.

It helps keep the cells that dissolve old bone, called osteoclasts, in check, giving the cells that build new bone, called osteoblasts, time to keep up. As oestrogen begins to fluctuate and decline during perimenopause, that brake loosens.

Bone breakdown can start to outpace bone formation, and the loss is often fastest during the few years around the final menstrual period, rather than decades later, as many women assume.

This is exactly why “I will deal with it after menopause” tends to be the wrong plan. The time when you may have the greatest influence is often now.

The Exercise That Actually Builds Bone

Bone responds to mechanical stress. Quite literally, it responds to being asked to bear more load than it is used to.

Three things matter most.

Resistance Training

Bone needs a genuine load to respond to. That means training with enough resistance that the final couple of repetitions feel properly difficult, rather than simply feeling as though you have done a bit of a workout.

Impact

Activities such as jogging, skipping and hopping create a jolt of force that walking simply does not.

If your only movement is walking or gentle Pilates, you are supporting balance and flexibility, which are both genuinely valuable. However, you may not be giving your bones the stimulus they need to become stronger.

Timing, Not Just Type

The timing of exercise and meals may also influence the way bone responds, although this area of research is still developing.

A 2024 review by exercise physiologist Katarina Borer, published in Nutrients, examined a series of small studies involving sedentary postmenopausal women. The research suggested that exercising after a meal may produce a more favourable response in short-term markers of bone formation than completing the same exercise while fasted.

Some evidence also suggests that bones temporarily become less responsive after mechanical loading and may respond again several hours later. However, it has not been established that completing two daily exercise sessions reliably doubles bone building, particularly in women going through perimenopause.

The practical message is not that you need to exercise twice a day. Rather, exercising consistently, avoiding prolonged fasting when undertaking demanding exercise and allowing adequate recovery may help support a well-rounded bone health plan. The strongest evidence still supports choosing appropriate resistance and impact exercises and performing them regularly.

What About Calcium and Vitamin D?

They are still essential, but intake is not the same as absorption.

Your body needs adequate vitamin D to absorb the calcium you consume. Stomach acid and gut health may also influence how much calcium is absorbed in the first place.

Simply increasing your calcium intake without considering absorption is a little like pouring more water into a leaking bucket.

There is also an interesting piece of nutrition research worth knowing about.

A 12-month randomised controlled trial from Penn State followed 235 postmenopausal women. Some participants ate no prunes, some ate 50 g, or approximately four to six prunes, each day, and others ate 100 g.

Women in the control group lost bone mineral density at the hip over the course of the year. Women who ate 50 g of prunes each day did not experience the same loss, and their total hip bone mineral density was preserved.

Prunes are not a miracle food, but this is a rare example of a wholefood intervention supported by measurable evidence of bone protection in postmenopausal women. It is also a much easier daily habit to sustain than taking a fistful of supplements.

A Note on Creatine

If you have read our previous article on muscle health during menopause, you will already know that creatine is not just for athletes.

It is worth mentioning here too, although the bone-health evidence needs to be kept in perspective.

A two-year randomised controlled trial examined creatine supplementation alongside exercise in postmenopausal women. Creatine did not produce a clear improvement in bone mineral density compared with placebo, although the researchers reported some favourable changes in bone geometry and physical function.

In other words, creatine may have a useful supporting role for some women, particularly when combined with resistance training, but it should not be presented as a proven treatment for preserving bone density. Exercise remains the real foundation.

What This Actually Looks Like From Week to Week

Pulling everything together into a realistic plan may look like this:

1. Complete two to three resistance-training sessions each week, working close to genuine effort rather than simply going through the movements.
2. Include some form of impact exercise where your body allows it safely. Even brief periods of skipping or stair climbing may count.
3. Aim to complete your main exercise session at a consistent time of day, with a proper meal beforehand rather than exercising while fasted.
4. Consider including 50 g of prunes on most days, alongside your usual calcium and vitamin D intake.
5. Have your vitamin D levels and, where appropriate, your bone density tested rather than assuming that adequate intake automatically equals adequate protection.

None of this requires perfection, and it does not all need to happen at once.

It does, however, need to be specific, because “stay active and eat well” was never going to provide enough information to act on.

You Do Not Have to Work This Out Alone

Bone health during perimenopause is not about fear. It is about making good use of the years in which you may have the greatest influence.

If you would like a plan built around your own bone density results, activity level and nutritional needs, rather than generic advice, this is exactly the kind of personalised assessment I provide at Handcrafted Health.

Consultations are available in Neutral Bay or by telehealth anywhere in Australia.

Ready to build a bone health plan that is genuinely yours? Book a discovery call or consultation with Sue at handcraftedhealth.com.au to get started.