PART 2 - How to Protect Your Bones in Perimenopause

In Part 1, we explored how declining oestrogen levels quietly influence bone health during perimenopause.

Now we shift into the practical part – what women can actually do to protect bone strength during this transition.

Perimenopause is not just a hormonal shift. It’s a window of prevention.

And the actions you take now will shape your mobility, strength, and independence for the decades ahead.

Let’s look at the evidence, the tools, and the integrative strategies that make the biggest difference.

1. Don’t Wait for a Fracture: Assess Your Bone Health Early

Most women only think about bone health when something goes wrong. But early changes are silent – and reversible when addressed promptly.

A. DEXA scan – your baseline

A DEXA scan remains the gold standard for measuring:

• Bone mineral density (BMD)

• Early signs of osteopenia or osteoporosis

• Fracture risk

But it shows only a snapshot of your bones.

B. Bone Turnover Markers (BTMs) – your dynamic picture

Bone turnover markers show how active your bone remodelling is right now. They provide insights into both bone formation and bone breakdown.

The key markers include:

• PINP (Procollagen Type I N-Terminal Propeptide) – a marker of bone formation, showing how actively your body is building new bone.

• CTX (C-Telopeptide of Type I Collagen) – a marker of bone resorption, indicating how quickly bone is being broken down.

• BSAP (Bone-Specific Alkaline Phosphatase) – an enzyme linked to osteoblast activity, another measure of bone formation.

• DPD (Deoxypyridinoline) – a urine marker of bone breakdown, showing collagen released during bone resorption.

• Osteocalcin – a protein produced by osteoblasts and used as a general indicator of bone formation and metabolism.

Together, DEXA + BTMs give a much more accurate picture. This combination is one of the most powerful tools for assessing your current bone health, as well as the effectiveness and the progress of the intervensions to improve it.

2. Hormone Therapy: The Most Effective Biomedical Intervention

Oestrogen is foundational for bone health. When levels fall during perimenopause, bone resorption accelerates.

This is why menopausal hormone therapy (MHT) remains the strongest evidence-based strategy for:

• Preserving bone density

• Reducing fracture risk

• Preventing rapid trabecular bone loss

Research shows the greatest benefit when MHT is started:

• Within 10 years of menopause

• Or before age 60

A 2025 study also found that MHT combined with resistance training improves bone density more than either intervention alone.

MHT must always be tailored to individual needs and risk‐benefit ratio. Hormones aren’t for everyone – but every woman deserves personalised, balanced guidance to make an informed decision.

3. Exercise: Load Is Medicine for Your Bones

Bones thrive under pressure. Without load, they weaken.

The right type of movement sends a clear message to your skeleton: grow, repair, stay strong.

Here are the most effective forms of exercise for bone health:

Resistance training

Examples: squats, lunges, deadlifts, resistance bands, Pilates reformer, weighted gym machines.

Benefits:

• Stimulates new bone formation by loading the skeleton

• Builds and maintains muscle mass, essential for balance and metabolic health

• Improves posture and joint stability, reducing fall risk

Weight-bearing exercise

Examples: brisk walking, hiking, stair climbing, low-impact aerobic classes.

Benefits:

• Strengthens lower-body bones, especially hips and spine

• Supports cardiovascular health and blood sugar regulation

• Easy to integrate into daily life

Impact or power training

Examples: jumping, skipping, hopping, jump squats.

Benefits:

• Provides short bursts of high mechanical load, which strongly stimulates bone growth

• Improves agility, balance, and neuromuscular coordination

• Particularly effective for maintaining hip and spine density

Small, sustainable routines performed regularly are far more effective than occasional intense workouts.

4. Nutrition and Supplementation: The Foundations of Bone Health

Bone is living tissue. It requires steady, reliable nutritional support to repair, rebuild, and stay strong.

Calcium

Essential for bone mineralisation – ideally obtained from food sources such as dairy, leafy greens, tofu, and fortified products.

When supplementing, choose calcium citrate (better bioavailability than calcium carbonate) and avoid exceeding 500 mg per day.

Magnesium

Works alongside calcium to form strong bone, support muscle function, and maintain healthy nerve signalling. Magnesium glycinate or citrate are generally well tolerated.

Vitamin D

Enhances calcium absorption, supports immune function, and helps maintain muscle strength – all essential for skeletal health. Many women need supplemental vitamin D, especially in northern climates.

Vitamin K2

Directs calcium into bones – not into soft tissue or arterial walls. It works synergistically with vitamin D to support safe and effective mineralisation.

Collagen

Provides the structural framework of bone. Supplementing with collagen may support bone density, joint health, and connective tissue resilience.

Additional micronutrients

Zinc, boron, and omega-3 fatty acids support bone formation, reduce inflammation, and enhance overall skeletal resilience.

These nutrients build the biological foundation upon which bone can regenerate, adapt, and stay strong through the perimenopausal transition and beyond.

5. Chinese Herbal Medicine: Multi-Targeted Support for Bone Strength

Chinese herbal medicine offers a unique perspective on bone health – one that views the body as a connected ecosystem rather than isolated parts.

Herbal formulas contain many anti-inflammatory and antioxidant active compounds that support bone metabolism, reduce chronic inflammation, and improve circulation, digestion, and hormonal balance.

Its value in supporting women with osteoporosis is widely recognised in clinical practice. However, because herbal formulas work through multi-targeted, multi-pathway mechanisms, the scientific evidence is still largely empirical, based on centuries of consistent clinical results rather than large-scale trials.

This complexity is a strength: herbal medicine supports the whole person, not just one symptom.

Personalisation is essential – formulas are tailored to the individual.

6. Awareness: The Missing Piece of Women’s Health

Understanding what is happening inside your body transforms midlife from something to simply endure into something you can actively work with.

This is what I observe in practice:

• Women who understand their physiology feel more empowered.

• They seek help earlier and respond better to treatment.

• They take proactive approach to long-term health.

Awareness changes outcomes.

A Final Reflection

Oestrogen supports the entire architecture of your skeleton. As levels decline during perimenopause, bone becomes more vulnerable – but this is also one of the most actionable stages of life.

Taking steps in your 40s and 50s shapes your posture, mobility, and strength for the decades to come.

But it is equally important to say this clearly: it is never too late.

Women in their 60s and 70s can still build strength, improve balance, increase muscle mass, and slow or even stabilise bone loss. The body remains adaptable throughout life – it responds to movement, nourishment, and targeted support at any age.

And perhaps the most important message is this: you don’t have to navigate this alone.

Bone health - like every aspect of wellbeing - benefits from guidance, continuity, and a personalised plan that evolves with you. Seek support from your doctor, and also from a practitioner who understands the whole picture: your hormones, nutrition, stress, sleep, emotional landscape, and the unique patterns of your constitution.

True recovery and resilience don’t come from a single appointment or a single prescription, but from a continuum - an unfolding process of recalibration, alignment, and genuine healing.