Most women do not think about their bones until one breaks. But the window for protecting bone density is perimenopause — the years before and immediately after menopause when bone loss accelerates most rapidly. What you do now determines your fracture risk at 70. And the good news is that there is a great deal you can do.
The Oestrogen-Bone Connection
Oestrogen is the primary regulator of bone density in women. It inhibits osteoclasts (cells that break down bone) and supports osteoblasts (cells that build bone). During perimenopause, as oestrogen declines, this balance shifts — bone breakdown outpaces bone building. Women can lose 10–20% of their bone density in the first five years after menopause.
⚠️ ⚠️ Australian statistics: Osteoporosis affects 1 in 4 Australian women over 50. One in three women over 60 will experience an osteoporotic fracture. Hip fractures in particular carry a significant mortality risk — up to 20% of patients die within a year.
Risk Factors
- Early menopause (before 45) — longer period without oestrogen protection
- Family history of osteoporosis or fractures
- Low body weight
- Smoking
- High alcohol consumption
- Low calcium intake throughout life
- Low vitamin D levels
- Sedentary lifestyle
- Long-term use of corticosteroids
Getting a Bone Density Scan
A DEXA scan (dual-energy X-ray absorptiometry) measures bone density and is the gold standard for diagnosing osteoporosis. In Australia, DEXA scans are Medicare-rebated for women over 50 with risk factors, and for all women over 70. If you have risk factors, discuss a DEXA scan with your GP.
Protecting Your Bones
- 1Calcium — 1,000–1,300mg daily from food sources (dairy, fortified plant milks, canned fish with bones, leafy greens)
- 2Vitamin D — maintain levels above 50 nmol/L; supplement if deficient (very common in Australia despite the sunshine)
- 3Weight-bearing exercise — walking, running, dancing, and strength training all stimulate bone formation
- 4Resistance training — particularly important for building and maintaining bone density
- 5MHT — oestrogen therapy is one of the most effective interventions for preventing perimenopausal bone loss
- 6Avoid smoking and limit alcohol