Most women associate bone loss with old age.

The truth is far more urgent, and far more actionable.

For many women, bone density loss begins quietly during perimenopause, years before menopause officially starts and long before fractures or osteoporosis enter the conversation. By the time bone loss is diagnosed, much of the damage is already done.

Understanding what’s happening before menopause—and why early action matters—can change the trajectory of your bone health for decades to come.

Perimenopause: The Overlooked Beginning of Bone Loss

Perimenopause is the transitional phase leading up to menopause, often beginning in a woman’s 40s or even as early as in the late 30s. Hormones fluctuate unpredictably, cycles change, and symptoms like sleep disruption, mood shifts, and hot flashes may appear.

What’s discussed far less: this is also when bone loss quietly accelerates.

Estrogen plays a central role in maintaining bone density. As estrogen levels become erratic during perimenopause, the balance between bone breakdown and bone rebuilding begins to shift, often in favor of loss.

Importantly, this process is:

• Silent (no pain, no symptoms)
• Progressive
• Cumulative over time

Bone loss doesn’t start at menopause. Menopause simply accelerates what’s already underway.

Why Waiting Until Menopause Is Often Too Late

Bone density peaks in early adulthood. From there, it’s a long game of preservation.

Research shows that:

• Bone loss begins to accelerate up to 2 years before menopause1
• Small annual losses compound into significant structural weakening
• The hip and spine, areas linked to life-altering fractures, are especially vulnerable

This is why prevention matters. Slowing bone loss earlier leads to dramatically different outcomes later.

Bone loss starts during perimenopause, but the greatest decline occurs in the first 10 years after your final period. After that, the rate of bone loss slows but continues over time. Women who enter menopause early or prematurely start losing bone at a younger age, leaving them at greater risk of low bone density and fractures later in life.2

Who Is at Higher Risk During Perimenopause?

While all women experience hormonal shifts, certain factors1 increase the risk of accelerated bone loss:

• Family history of osteoporosis or fractures
• Lower estrogen exposure (early menopause, irregular cycles)
• Higher body fat percentage or metabolic changes
• Low muscle mass or sedentary lifestyle
• Nutrient absorption issues, including gut health disruptions

It was once thought that higher BMI was linked to protection against osteoporosis, but newer evidence shows that higher levels of body fat can predispose women to fractures.

The Gut-Bone Connection: A New Frontier in Prevention

Traditionally, bone health conversations focus on calcium, vitamin D, and exercise. These remain important, but they are only part of the picture.

Emerging research highlights the gut-bone axis: the role of the microbiome in regulating inflammation, mineral absorption, and bone metabolism.

A healthy, functioning gut helps:

• Improve calcium and nutrient absorption
• Reduce chronic, bone-eroding inflammation
• Support signaling pathways that influence bone remodeling

This insight has opened the door to new, prevention-focused strategies that work with the body’s biology rather than trying to correct damage later.

What the Clinical Evidence Now Shows

In a 12-month, randomized, double-blind, placebo-controlled clinical trial3 involving 286 early postmenopausal women, researchers studied a plant-sourced, live-culture synbiotic designed to support bone density through the gut.

The results were striking:

• Bone density loss was slowed by up to 85% in women with osteopenia (low bone mass)3
• Women with osteopenia taking placebo lost bone at 6.5x the rate of those receiving the intervention
• The strongest preservation was seen at the femoral neck, a region closely linked to hip fracture risk

These findings matter because they validate a critical point: bone loss is modifiable earlier than we once believed.

What Women Can Do During Perimenopause

Perimenopause is not a waiting room. It’s a window.

Steps that matter now:

1. Ask for baseline screening, including DXA scans
2. Prioritize resistance training and impact-appropriate movement
3. Support nutrient absorption, not just intake
4. Address gut health as part of a bone health strategy
5. Choose interventions backed by clinical evidence, not trends

Bone health isn’t about panic. It’s about preparation.

The Bottom Line

Bone loss is a silent process. But it’s not inevitable, and it’s not untouchable.

Perimenopause represents one of the most powerful opportunities women have to protect their future mobility, independence, and quality of life. With better science, earlier awareness, and proven preventive tools, women no longer have to wait for a diagnosis to act.

Your skeleton carries you through every stage of life.

It deserves attention long before menopause arrives.

A Note on Evidence-Based Prevention

For women looking to take proactive steps during perimenopause, emerging clinical research suggests that supporting bone health through the gut-bone axis may be a promising strategy.

One example is Bōndia, a plant-sourced, live-culture synbiotic developed by Sōlaria Biō. In a gold-standard clinical trial3, Bōndia was shown to significantly slow the rate of bone density loss in groups of early postmenopausal women, including those with osteopenia or elevated body weight, with the strongest preservation seen at the hip.

For those interested in learning more about the science behind this approach, you can explore the published research and clinical findings at sōlaria.biō.

Disclosure: The author serves as a scientific advisor to Sōlaria Biō. This article is intended for educational purposes only and does not constitute medical advice. Readers should consult a qualified healthcare professional regarding individual health decisions.

References

1 Lo JC, Burnett-Bowie SA, Finkelstein JS. Bone and the perimenopause. Obstet Gynecol Clin North Am. 2011 Sep;38(3):503-17. doi: 10.1016/j.ogc.2011.07.001. PMID: 21961717; PMCID: PMC3920744.

2 Ahlborg HG, Johnell O, Nilsson BE, et al. Bone loss in relation to menopause: a prospective study during 16 years. Bone. 2001;28(3):327–331. doi: 10.1016/s8756-3282(00)00451-8.

3 Schott EM et al., Osteoporosis International (2025). DOI: 10.1007/s00198-025-07650-7