Protecting your bones through perimenopause and beyond

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A woman I’ll call Helen came to me at 49, a few weeks after she’d slipped on a wet kitchen floor, put her hand out to catch herself, and broke her wrist. “I felt ridiculous,” she told me. “It was barely a fall. I’m not old. Why did my wrist just… snap?”

Helen’s reaction is one I hear often, and the answer surprises most women: a wrist that breaks from a minor fall in your late 40s is not a clumsy accident. It can be the first visible sign of something that’s been quietly happening for years, and it’s something you have far more influence over than you might think.

Let’s talk about your bones. Not in a frightening way, but in the way I wish someone had explained it to me long before my own midlife.

Why your bones are a perimenopause issue, not an “old age” issue

Most of us file osteoporosis under “things that happen to elderly people.” But the story really begins much earlier, and oestrogen is the main character.

Think of your skeleton like a bank account. Through childhood and your twenties, you’re making steady deposits, building bone faster than you lose it. You reach your peak balance, your strongest and densest bones, at around age 30. From there, things stay roughly in balance for a couple of decades. Then perimenopause arrives, and the rules change.

Oestrogen is one of the key hormones that protects bone. As it becomes erratic and then falls through perimenopause and into menopause, bone loss speeds up sharply. According to the Australasian Menopause Society, the average woman can lose up to 10% of her bone mass in the first five years after menopause. That’s a significant withdrawal from the account, made over a fairly short window, and it often happens silently while you’re busy with everything else midlife throws at you.

This is exactly why I think bone health belongs in the perimenopause conversation, right alongside hot flushes, sleep and mood. The years when many women feel most dismissed by the health system are the very years their bones need attention most.

Here’s what I wish every woman understood in her forties: the bone you protect now is, in a very real sense, the independence you get to keep at eighty.

The tricky part: bones don’t warn you

Osteoporosis means bones gradually lose density and strength, so they break more easily. The hard thing about it is that it’s almost completely silent. Healthy Bones Australia calls it “the silent disease” for good reason. There are usually no symptoms at all until a bone actually breaks. You can’t feel your bones thinning the way you can feel a sore knee.

And it’s far more common than most people realise. In Australia, around two-thirds of people over 50 have either osteoporosis or osteopenia (osteopenia being the milder, earlier stage of low bone density). It is not a rare condition affecting an unlucky few. It’s something most of us will need to think about.

Because there are no symptoms, the only way to actually measure bone density is with a scan. The standard test is a DXA scan (dual-energy X-ray absorptiometry). It’s quick, painless, and uses very low-dose X-rays, as the Australian Institute of Health and Welfare describes. It usually looks at your hip and spine and gives your doctor a clear number to work with.

Here’s the important bit: not everyone needs a DXA scan, and it’s your GP who decides who does, based on your individual risk. So rather than worrying about whether you should “get scanned,” the more useful step is to have a conversation with your GP about your own risk factors, which brings me to the next part.

What raises your risk (and what you can do about it)

Some risk factors you can’t change, and there’s no point worrying about those, but it’s worth knowing them, because they’re exactly what your GP weighs up. Others are very much within your control.

Things to flag with your doctor, because they raise risk:

• A previous broken bone from a minor fall, like Helen’s wrist
• A parent who broke a hip
• Early menopause (before 45) or premature menopause (before 40)
• Long-term use of certain steroid medicines
• Low body weight
• Smoking, and drinking alcohol heavily
• Some medical conditions (your GP will know which)
• Frequent falls

If a few of those apply to you, please don’t read it as bad news. Read it as useful information. Knowing your risk early is a gift, because nearly everything that protects your bones is something you can start today. Let’s get to the hopeful part.

The good news: bones respond to what you do

Bone is living tissue. It rebuilds and responds throughout your whole life, which means the choices you make in midlife genuinely shape the strength of your skeleton for decades. Here’s what actually helps, based on the best Australian guidance.

Calcium, from food first

Calcium is the raw material your bones are built from, so getting enough matters. The evidence is clear that food is the best source: dairy like milk, yoghurt and cheese; tinned fish where you eat the soft edible bones (think salmon or sardines); calcium-fortified plant milks; and some leafy greens.

Supplements have their place, but only if you genuinely can’t meet your needs through food, and more is not better. Taking large amounts of calcium in supplement form doesn’t give you stronger bones, and your GP or an Accredited Practising Dietitian can help you work out whether you actually need one. For specific daily targets, Healthy Bones Australia has clear, Australian guidance.

Vitamin D, mostly from the sun

Vitamin D is what allows your body to absorb the calcium you eat, so the two work as a team. The main source isn’t food. It’s sunlight on your skin. For most Australians, sensible sun exposure does the job, though this gets harder in winter, in southern states, and for anyone who covers up or spends most of their time indoors.

If your levels are low or your sun exposure is limited, a supplement can help. healthdirect notes that Healthy Bones Australia suggests aiming for a vitamin D level of at least 50 nmol/L at the end of winter. A simple blood test through your GP can tell you where you stand.

Protein, spread across the day

Bone isn’t just minerals; it has a protein framework too, and your muscles (which protect your bones) need protein to stay strong. Aim to include some good-quality protein across each meal rather than loading it all into dinner. This is one of those quiet habits that supports both bone and muscle as we age.

Exercise, the kind that actually builds bone

If I could underline one section, it might be this one, because the right exercise is genuinely protective, and many women have been frightened away from it by the idea that lifting anything heavier than a handbag will hurt them. The opposite is true.

The Exercise and Sports Science Australia position statement and Healthy Bones Australia both point to a specific combination of three things:

• Strength (resistance) training, around twice a week, using weights, machines or resistance bands. Working your muscles against resistance is one of the most effective ways to signal your bones to stay strong. Done properly and supervised, this is protective, not dangerous, even for women who already have low bone density.
• Weight-bearing impact on most days. This means activity done on your feet where you carry your own weight: brisk walking, stair climbing, jogging, dancing, even hopping. Swimming and cycling are wonderful for your heart, but they don’t load your bones the same way.
• Balance training, because the single biggest cause of a fracture is a fall, and better balance means fewer falls. Something as simple as practising standing on one leg counts.

A gentle word of care: if you have diagnosed osteoporosis or you’re frail or higher-risk, this is worth doing under the guidance of a physiotherapist or exercise physiologist, who’ll tailor it safely to you. There are also a few movements better approached with care if your bones are fragile, such as deep forward bends and twisting motions of the spine. That’s another good reason to start with professional guidance rather than going it alone. The goal isn’t to avoid moving; it’s to move in the way that builds you up.

Preventing falls, the unglamorous essential

Because bones break when we fall, falls prevention does just as much work as anything you swallow or lift. The practical checklist is reassuringly ordinary: clear away trip hazards like loose rugs and clutter, improve the lighting in your home, keep your vision check up to date, wear supportive non-slip footwear (those comfortable old slippers may not be doing you any favours), and ask your GP to review any medications that leave you dizzy or lightheaded.

The everyday habits

Three more that round out the picture: don’t smoke (smokers lose bone faster), keep alcohol moderate, and, importantly, flag any rapid or unexplained weight loss to your doctor, as it can be a sign worth investigating.

A word about treatments

For some women, lifestyle is enough. For others, particularly those at higher risk of fracture, their doctor may discuss medication. I want to demystify this a little without straying into advice that only your own clinician can give.

Effective medicines exist that strengthen bone and substantially reduce the chance of fractures. They come in different general forms, including tablets, injections and infusions, and there’s no single “best” one. Which type suits you depends on your individual situation, and that’s a conversation for you and your GP or specialist, not something to sort out from a blog or a forum.

There’s one safety message I genuinely want every woman on bone medication to hear, because it matters:

This is well documented in the clinical literature, and it’s the kind of thing that’s easy to get wrong if no one explains it.

And on the worries people read about online, the rare jaw problems and the unusual thigh-bone fractures: these are genuinely rare at the doses used for osteoporosis, and tend to be associated with the much higher doses used in other conditions, such as some cancers. The benefit of preventing fractures generally far outweighs these small risks for people who need treatment. Keep up your normal dental care, let your dentist know you’re on a bone medicine, and please don’t stop treatment out of fear. Raise your concerns with your doctor instead, so you can make a calm, informed decision together.

You have more control over this than you think

I started with Helen and her broken wrist, so let me finish her story. That fracture turned out to be a beginning, not a verdict. She talked to her GP, had her risk properly assessed, sorted out her vitamin D, started strength training with an exercise physiologist she now adores, and tidied the trip hazards out of her hallway. A few years on, she feels stronger and more capable than she did at 45, not despite midlife, but because midlife was the moment she paid attention.

That’s the message I want you to take from all of this. Bone loss in perimenopause is quiet, common and real, but it is also one of the most responsive parts of your health. It’s never too early to start protecting your bones, and it’s never too late to make a difference. The small, consistent things you do in your 40s and 50s are an investment in the active, independent decades that follow.

If you’re not sure where you stand, the best first step is simply a conversation with your GP about your own risk. And if you’d like a thinking partner alongside that, my door is open.

A good resource to explore further: Healthy Bones Australia.