Maintaining Bone Health During Perimenopause

There’s no good time to go through the challenges of menopause, but it can be particularly tough for women in India, considering that this transition begins about five years earlier as compared to women in the West — in our early 40s, when we’re taking on more responsibilities at the workplace and at home. Preparing for these changes during perimenopause can make a huge difference to your quality of life, health outcomes, and ability to cope with menopause eventually. As you probably know, one of the biggest health challenges for post-menopausal women is the high risk of osteopenia and osteoporosis. Osteoporosis affects 33–53% of Indian women during peri- and postmenopause, a rate significantly higher than that seen in many Western populations. Many of the changes that drive these risks begin before you even enter menopause, during the transition period known as perimenopause. This is why it’s so important to understand the impact of perimenopause on bone health and to begin taking preventive care as soon as possible.

Why bone health is crucial during perimenopause

Perimenopause is a high-risk period for bone loss as ovarian ageing is associated with declines or fluctuations in levels of ovarian hormones, including estradiol and progesterone, as well as a rise in follicle-stimulating hormone (FSH) levels. These changes disturb the balance between bone breakdown and formation. The rate of bone loss typically accelerates in late perimenopause — a few years before the final menstrual period. On average, the rate of perimenopause bone loss can be as high as 2.3% in the lumbar spine and 1.4% in the hip each year. Elevated serum FSH levels in perimenopause are linked to bone loss, independent of changes in estradiol levels.

As bone loss during this critical period will heavily influence the risk of osteoporosis and bone fractures later in life, early intervention is critical. You can make lifestyle changes and seek treatment to slow or prevent bone loss during this period, significantly lowering your risk.

Can your hip bones get wider in perimenopause?

It’s a common misconception that the hip bones widen during perimenopause or menopause, but this is simply not true. It’s understandable why this myth persists; however, as perimenopause-related hormonal changes trigger a redistribution of body fat, which may create the perception of hip widening. There is no actual change in bone structure — loss of muscle tone, postural changes, and other age-related changes can affect bone dimensions to a small extent, but the hip bones do not actually widen.

Signs of bone weakness you shouldn’t ignore

While you shouldn’t wait for warning signs of bone weakness to appear before taking action, it’s important to recognise them as soon as they appear. Don’t ignore these signs:

• Fragile bones that fracture easily from a low-impact fall or a minor bump

• Frequent fractures despite no change in lifestyle

• Sudden or unexplained back pain

• Postural changes, such as stooping or a loss of height

• Reduced grip strength or difficulty holding objects

• Loosening of teeth or receding gums

Self-care for osteoporosis prevention

Self-care during perimenopause to strengthen bones and joints is crucial, as this can help prevent or delay osteoporosis later in life. Many behavioural and dietary choices during this period directly influence bone health and strength as you age.

Practical self-care measures include regular exercise, particularly weight-bearing and resistance training, to stimulate bone formation and maintain muscle strength that helps prevent falls. Balance exercises are equally important, as they lower fall risk. Ensuring adequate calcium and protein intake, avoiding tobacco, limiting excess alcohol, and maintaining a healthy body weight are also key to protecting and strengthening bones during perimenopause and beyond.

Essential vitamins for strong bones and joints

While calcium undoubtedly is the most important of all nutrients when it comes to bone health, supporting bone mineralisation and skeletal strength, it is not the only nutrient that you need to preserve bone and joint health. Some other essential vitamins and minerals include:

• Vitamin D for calcium absorption

• Adequate protein for bone matrix and muscle function

• Vitamin K for bone mineralisation

• Magnesium for bone formation and regulation of calcium metabolism

• Phosphorus for bone formation and structural support

Diet tips to support bone strength

The quality of your diet is important for supporting bone health during perimenopause, as well as lowering the risk of long-term health complications that are linked to menopause. Here are some diet tips that you should follow.

• Boost your calcium intake with dairy products and fortified foods.

• Check vitamin D levels and increase your intake with fatty fish, eggs, and fortified foods.

• Increase protein consumption with lean meats or legumes and dairy products.

• Have more leafy greens like kale and spinach to get more calcium and vitamin K.

• Nuts, seeds, whole grains and legumes can provide essential nutrients like magnesium, phosphorus, and trace minerals.

• Limit excessive salt and very high-caffeine intake, as this is associated with calcium loss.

• Avoid heavy alcohol consumption, as it is a major risk factor for bone loss and osteoporosis.

Stay ahead with proactive care

Maintaining strong, healthy bones during perimenopause is essential for long-term well-being. As hormone levels fluctuate, taking proactive steps, such as staying active, eating a calcium-rich diet, getting enough vitamin D, and discussing bone health with your healthcare provider, can make a significant difference. By prioritising bone care now, you’re investing in a healthier, more resilient future.

Frequently Asked Questions

1. Does bone loss begin during perimenopause?

Yes, bone loss can begin during perimenopause as many of the triggering hormonal changes begin at this time.

2. How to maintain bone health during perimenopause?

A healthy, balanced diet that provides adequate intake of calcium, protein, and other essential nutrients, along with strength training exercise, is crucial to maintain bone health.

3. Does weight training help strengthen bones?

Yes, weight training doesn’t just improve muscle mass and strength; it also triggers increases in bone formation and bone density.