Perimenopause and bone health: What to track

Bone loss accelerates during the menopause transition—but tracking the right factors early can help you and your healthcare provider make informed decisions about prevention.

Why bone health matters during perimenopause

The numbers are significant:

• Women can lose up to 20% of bone density in the 5-7 years after menopause
• Estrogen plays a crucial role in bone maintenance
• Bone loss often begins in late perimenopause, before periods stop
• Early intervention is more effective than treating established osteoporosis

What to track for bone health

DEXA scan results

If you've had bone density scans, track:

• T-score: Compares your bone density to healthy 30-year-olds
• Z-score: Compares to others your age
• Specific sites: Spine, hip, forearm
• Date of each scan for trend comparison

T-score interpretation:

• Above -1.0: Normal bone density
• -1.0 to -2.5: Osteopenia (low bone mass)
• Below -2.5: Osteoporosis

Daily tracking

1. Calcium intake (food and supplements)

   • Target: 1000-1200 milligrams daily
   • Log dairy, leafy greens, fortified foods, supplements

2. Vitamin D

   • Supplements and sun exposure
   • Blood levels if tested

3. Weight-bearing exercise

   • Walking, jogging, dancing, tennis
   • Resistance training (weights, bands)
   • Frequency and duration

4. Falls and near-misses

   • Date and circumstances
   • Any injuries
   • Balance concerns

Risk factors to document

Note these for provider discussions:

• Family history of osteoporosis or fractures
• Personal fracture history
• Medications that affect bone (steroids, certain others)
• Smoking status
• Alcohol intake
• Body weight (low weight increases risk)
• Early menopause (before 45)

Creating a bone health baseline

If you haven't had a DEXA scan, track your risk factors and discuss timing with your provider. Consider:

• Standard recommendation: First DEXA at age 65 (earlier with risk factors)
• Perimenopause consideration: Some providers recommend baseline scans around menopause
• Personal factors: Family history, fracture history, medication use

Exercise tracking for bones

Log weight-bearing activities:

| Activity | Bone benefit | Track | |----------|--------------|-------| | Walking | Good | Duration, frequency | | Jogging/running | Better | Duration, frequency | | Dancing | Good | Type, duration | | Tennis/sports | Good | Frequency | | Weight training | Excellent | Exercises, weight, sets | | Yoga | Moderate | Balance-focused poses |

Track both cardio and resistance training—both matter for bones.

Nutrition tracking

Key nutrients for bone health:

Calcium sources to log:

• Dairy products (milk, yogurt, cheese)
• Fortified plant milks
• Leafy greens (kale, bok choy, broccoli)
• Canned fish with bones
• Calcium supplements

Vitamin D sources:

• Supplements (most common reliable source)
• Fatty fish
• Fortified foods
• Sun exposure (limited reliability)

Questions for your provider

Bring tracking data and ask:

• When should I get a baseline DEXA scan?
• What's my fracture risk based on my factors?
• Is my calcium/vitamin D intake adequate?
• Should I have vitamin D levels checked?
• What role might hormone therapy play for bone health?
• Are there medications to consider for prevention?

The hormone therapy connection

Estrogen helps maintain bone density:

• Hormone therapy can prevent bone loss during menopause
• Effect is maintained while taking therapy
• Bone loss resumes when therapy stops
• Not the only option but an important consideration

Track bone health markers before and after any hormone therapy decisions.

Warning signs to track

Note and report:

• Height loss (measure annually)
• Back pain (could indicate compression fractures)
• Stooped posture developing
• Any fractures from minor trauma

The bottom line

Bone loss accelerates during perimenopause and early menopause, making this an important time for tracking and prevention. Log your calcium intake, weight-bearing exercise, and risk factors. Keep records of any DEXA scans for trend comparison.

This data helps you have informed conversations with your healthcare provider about prevention strategies—whether lifestyle-focused, supplement-based, hormonal, or pharmaceutical—based on your personal risk profile.