Perimenopause: The Bone Health Turning Point No One Talks About
Perimenopause is a wild ride—one that can start in your 30s and stretch into your 50s. Symptoms show up unpredictably: irregular cycles, sleep trouble, mood swings, random aches, and those infamous hot flashes (because nothing says “fun” like suddenly overheating in a cozy café on a snowy day).
But there’s one major shift no one really talks about… the one happening quietly inside your bones.
Perimenopause is actually a critical window for bone health. Because bone density loss accelerates during this time, and after menopause begins, women can lose up to 20% of their bone density in just five years. The good news? Osteoporosis prevention absolutely can start now—and perimenopause is the perfect time to make moves that protect your bones for the long haul.
That’s where expert guidance becomes essential—especially from someone who understands how perimenopause and bone health intersect.
Osteoporosis Prevention with Dr. Aurora
Dr. Aurora works with many perimenopausal women on osteoporosis prevention here at A Life in Balance (ALIB), our physical therapy Flemington NJ location. She makes an important point about bone density and perimenopause that she wishes every woman knew:
“There is actually a close relationship between muscle and bone health, and both are significantly impacted by perimenopause,” she explains. “Estrogen decreases in perimenopause, and this not only affects bone density but also impacts muscle mass. Muscles are very important to bone health because when muscles contract, especially under resistance/a load, they pull on bones, which stimulates bone growth and leads to higher bone mineral density. Therefore, it is just as important to focus on bone health as it is to train your muscles during perimenopause.”
This sets the stage for one of the most important takeaways in women’s health: your body is highly adaptable during perimenopause—you just need to know how to take advantage of that high-plasticity window.
Why Perimenopause Is a Critical Window for Bone Health
Bone loss, one of the silent symptoms of perimenopause, occurs because of declining estrogen levels. Estrogen not only regulates your menstrual cycle—it also protects your bones. As estrogen decreases, bone rebuild slows, resulting in a natural loss of density over time.
The average bone-loss rate through perimenopause is about 1% to 2% per year. But as Dr. Aurora emphasizes, there is enormous potential for positive change during this phase:
“It’s easy to let bone loss slip by during perimenopause because you can’t feel it happening, and people don’t talk much about it,” she says. “Awareness of these changes should spur healthy behavior changes to proactively enhance bone health. This is especially important because perimenopause is a high-plasticity window, which means the body is more susceptible to change during this time. Bone remodeling rates quickly fluctuate during this time, and this can be taken advantage of with the proper training and behavior modification. This high-plasticity window also applies to muscles, which are also very important. So, this is a great time to integrate strength training into these healthy behavior changes.”
Early Detection for Osteoporosis: What It Actually Means
Several factors influence bone health, but focusing on what you can control creates the biggest impact:
Staying active, especially with strength training
Eating a nutritious, calcium-rich diet
Getting enough vitamin D
Avoiding smoking
Limiting alcohol
Improving sleep and reducing stress
Genetics and hormonal shifts also play a role, but lifestyle habits still carry substantial power.
Getting a bone density scan once you begin noticing perimenopause symptoms can provide a helpful baseline. As Dr. Aurora explains:
“Sleep habits and stress levels play a key role in bone health, but are often overlooked,” she says. “Poor sleep and chronic stress increase cortisol, which is a hormone that increases bone breakdown. Because perimenopause already involves increased bone breakdown, elevated cortisol at this stage has an even larger impact. Good sleep also facilitates bone and muscle repair! It’s also worth noting that elevated stress can lead to behaviors that negatively impact bone growth, like poor nutrition, increased sitting, and lower motivation for health behavior changes. Paying attention to sleep habits and healthy stress management techniques can make a large difference, especially in this high-plasticity window when positive behavior changes can make a huge difference.”
This is why early detection is not about fear—it’s about clarity.
Physical Therapy for Balance and Bone Health: How it Helps During Perimenopause
Every woman experiences perimenopause differently, which means movement and strengthening strategies should be individualized—not generic. That is exactly what ALIB specializes in. Whether you visit our physical therapy Flemington NJ office or our physical therapy Manchester VT location, your PT team will guide you through an approach designed for your body and your goals.
ALIB’s personalized osteoporosis prevention and physical therapy for balance programs may include:
A movement and posture assessment to identify any imbalances
Strengthening for the core, hips, pelvic floor, and spine
Safe, simple load-bearing exercises like walking, stair climbing, and chair sit-to-stands
Balance and neuromuscular training to enhance joint stability
Education on ergonomics and healthy movement patterns
And because our physical therapy sessions are tailored to you, progress happens at your pace—not anyone else’s.
Women who proactively support bone health during perimenopause through physical therapy, balance training, and strength work can reduce fall risk by 36% to 41%, a powerful reminder that movement truly is medicine. As Dr. Aurora explains:
“A lot of people don’t realize you can actively improve bone density through movement and that you can use physical therapy to help before you see bone mineral density changes on a scan,” she says. “PT can also help you address conditions such as pain and old injuries that may be barriers to engaging in helpful bone-building exercises like resistance training, weight-bearing, and jumping. PT can also facilitate your form to optimize muscle loading and therefore, impact how growth is stimulated.”
Small, Supportive Shifts Make a Meaningful Difference in Bone Health
Bone health doesn’t require a major lifestyle overhaul. What matters most is consistency and awareness. Key small shifts include:
Noticing how much load-bearing movement you get in a day
Observing changes in balance, stiffness, or posture
Recognizing when fatigue signals the need for support
Choosing personalized strength work rather than “one-size-fits-all” routines
Adding small movement habits with the guidance of a trained physical therapist
Perimenopause is a time when the body responds quickly to positive change. Small, steady efforts add up in significant ways. Dr. Aurora reinforces this empowering message:
“People often think of certain changes during perimenopause as inevitable. They think that bone loss, weakened strength, and declines in balance are just an inevitable part of aging. But this is not the case! All of these things can be improved with practice. If you can incorporate even a short balance and strengthening program into your health routine just two days a week, this can make a big difference. Start small and increase frequency and intensity as you are able. You can always ask a PT to help get you started!”
Your Next Step Toward Stronger Bones
Perimenopause isn’t just a phase to push through—it’s a powerful turning point for your long-term bone health. With the right awareness and movement strategy, you can strengthen your bones, improve balance, and set yourself up for decades of confident, capable living.
That’s exactly why we’re offering:
Your Bones in Balance: A Workshop Series for Bone Health As You Age
A 3-part workshop series designed to support you through every stage of hormonal change and its impact on your bones:
Part 1: Perimenopause & Bone Health (How early hormonal shifts influence bone density—and what you can do now to stay strong.)
Part 2: Menopause & Movement (Understanding the next stage of bone and muscle changes, and how targeted strength work keeps you resilient.)
Part 3: Fall Prevention & Balance Training (A practical, movement-based session to help you stay steady, reduce fall risk, and protect your bones as you age.)
We’d love to have you join us for Part 1 on Monday, January 26th, at 7:15pm, whether you're learning, preparing, or ready to take action on your bone health. Click HERE to sign up!
And if you want personalized support sooner, you can schedule an appointment at either of our ALIB locations—Flemington, NJ or Manchester, VT—for a one-on-one physical therapy evaluation tailored to your bone health, balance, and strength goals.
Stronger bones are absolutely within reach—and we’re here to help you get there.
