A period of fast bone loss starts one year before the final menstrual period, the Study of Women’s Health Across the Nation says. Bone health is often treated as a postmenopause issue, but the timing is earlier than many women are told. That makes perimenopause a biologically active window, not just a symptom phase, and the right moment to start looking at fracture risk, family history, movement and whether screening is sensible.
Bone loss starts before the final period
Bone loss leading to osteoporosis begins before menopause, even though osteoporotic fractures usually happen later in older postmenopausal women. The rapid-loss phase typically arrives when there has been no bleeding for three months or more, but some bleeding has still occurred in the previous year. That is a useful clinical clue for women who are still having irregular periods and assume bone health can wait.
Do not wait for the final period before asking whether your bones need attention. If your cycle has become erratic, you are in the age band where perimenopause is likely, and you also carry other risk factors, this is the point to bring bone health into the conversation. The timing matters because the slope can start to shift before menopause is officially confirmed.
How UK fracture-risk assessment works
The National Osteoporosis Guideline Group’s 2024 summary, updated in September 2024, applies to postmenopausal women and to men aged 50 or older. It centres fracture-risk assessment rather than relying on a single bone-density result. A scan is not the whole story.
Section 3 of the guideline lists the variables used in tools such as FRAX, including age, sex, body mass index, previous fragility fracture and other clinical risk factors that should prompt assessment. FRAX estimates absolute fracture risk using clinical factors, while DXA measures bone mineral density. They answer related but different questions, and in practice they are often most useful together.
For women in perimenopause, that means the question is not, “Am I postmenopausal enough yet?” It is, “Do I already have enough risk factors to justify an earlier review?” If the answer is yes, a clinician can decide whether FRAX, DXA or both make sense.
Who should ask for an earlier review
Certain histories should push bone health higher up the list before the final period has happened. Early menopause, low body mass index, smoking, long-term steroid use, a family history of fragility fracture and any previous low-trauma fracture are clear risk flags. A woman with one of these factors does not need to wait for menopause to be “complete” before asking for a risk check.
That conversation should include more than a scan request. Ask about your fracture-risk factors, your nutrition and whether your movement pattern includes enough weight-bearing exercise to support bone strength. A 2023 SWAN study on leisure-time physical activity and bone mineral density preservation during the menopause transition and postmenopause suggests exercise may help mitigate bone loss across this life stage.
What a quick self-check can and cannot do
The Royal Osteoporosis Society’s Great British Bone Check is a public-facing starting point rather than a diagnosis. Osteoporosis is a condition where bones lose strength and become more likely to break, and the Royal Osteoporosis Society estimates that over 3.5 million people in the UK are currently living with the condition. The check takes just five minutes and gives a personalised report on bone health.
That makes the tool useful for opening a conversation, especially if you are unsure whether your symptoms and history justify a GP appointment. The Great British Bone Check is a guide and not a replacement for medical advice.
Women’s Health Concern and the British Menopause Society say osteoporosis affects around three million people in the UK. Postmenopausal women are by far the commonest sufferers, but younger women, men and very occasionally children can also be affected.
Why earlier diagnosis matters in real life
The Royal Osteoporosis Society has been campaigning for the extension of Fracture Liaison Services, the pathway designed to improve early diagnosis after a fracture. A first break can be the point at which osteoporosis finally becomes visible, when the bone loss has already been going on for years. By the 2024 Great British Bone Check launch, more than 29,000 people had already used the checker since its 2023 start.
Sam Mitchell, 50, from Gwaun-Cae-Gurwen in Neath Port Talbot, said she now lives in fear of another break after a minor fall and a pelvic fracture.