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  • Writer's pictureSimmone Cser

Perimenopause. Let's talk Bone & Muscle Health

Updated: Oct 22

Moving into perimenopause and menopause, women are at a higher risk of bone and muscle loss. Both go hand in hand. It is so important to keep our bones and muscles strong as we age.

OSTEOPOROSIS - Osteoporosis means OSTEO = Bones, Porosis = poor, fragile, brittle. It is a medical condition in which the bones become brittle and fragile through lifestyle factors, a deficiency of calcium or vitamin D, hormonal and age related changes and from loss of skeletal muscle tissue.

A DEXA scan is a type of medical imaging test. It uses very low levels of x-rays to measure how dense your bones are. DEXA = “dual-energy X-ray absorptiometry". There are 2 different types of scores used to measure bone density.

There are a T Score , which refers to comparing your bones to that of a 30 year old while a Z Score compares you with others of your age.

  • NORMAL BONE DENSITY = T-score of -1.0 or above.

  • OSTEOPENIA or low bone density= T-score between -1.0 and -2.5.

  • OSTEOPOROSIS = T-score of -2.5 or lower.

Osteopenia is not as serious as osteoporosis, however it does indicate there is a greater chance of developing osteoporosis.

What about Muscles?

Sarcopenia is the gradual loss of muscle mass, strength and function. And is frequently observed in postmenopausal women and is often associated with osteoporosis. Studies show that after menopause, muscle mass declines at an annual rate of 0.6%. Studies have also shown that the reduction of the most potent female hormone, estradiol during perimenopause and menopause, plays a role in the decline of muscle mass, as skeletal muscle tissue have specific receptors for estradiol, meaning this hormone is important in promoting skeletal muscle regeneration.


By undertaking OSTEOGENIC EXERCISE. Which is put simply are bone forming activities.


For an exercise to build bone (osteoblasts/anabolic process or growth) you need to be lifting a load that is at least 85% and up to 95% effort of your 1 rep max. For example if 30kg is the max load that you can lift just once, then 85% of this would be 25.5kg and you would therefore be lifting this weight 3-6 times.


High-impact exercises are an effective strategy to enhance bone density, and potentially reduce compression fractures in postmenopausal women. Higher impact activities, such as jogging and jumping rope, tennis, increase the weight on the bones and provide more bone-strengthening benefits (osteoblast activity).


Bones need variety as they came become accustomed to the same same patterning of movement, which is known as cellular accommodation. When cells become accustomed to a certain kind of loading they stop responding. Moving in different ways and modalities keep it interesting for our bones, as our muscle tendons place different stressors on them, exciting them to get active and grow. Laying down new bone is not an overnight process, it can take up to 6 months to notice positive changes in bone density.


It is well regarded that yoga, as a stand alone practice, will not build bone. It can assist you with teaching good form to then integrate a load to a movement in strength training, which will build bone.

Pilates sit's somewhere in-between, but again as a stand alone practice there are no conclusive studies that confirm Pilates alone will build bone to the extent of strength training or high impact training. The difference with Pilates is that we can challenge the body with spring load (*to a point), and the movements can be more dynamic. Adding strength training, as well as your Pilates practice can be bone building. Building bone requires the load of the activity to be high. Variety of activity is important as bones get tired of the same old same old and high impact activities increase bone building cells.

So you may like to add tennis and strength training to your Pilates and yoga practice to have a well rounded variety of bone satisfying movement.

*Disclaimer. I am in no way a medical provider and this presentation is not intended as medical advice or advocation for or against any specific treatment. My experience with perimenopause is unique to me as yours is unique to you. Consult with your health care provider for advice and treatment options.


Alexander Muacevic and John R Adler (2023). The Role of High-intensity and High-impact Exercises in Improving BoneHealth in Postmenopausal Women: A Systematic Review.

Tobie J. de Villiers (MBChB, MMED (O&), FCOG (SA), (2023). Bone health and menopause: Osteoporosis prevention and treatment.

Annalisa Geraci, Riccardo Calvani, Evelyn Ferri, Emanuele Marzetti, Beatrice Arosio and Matteo Cesar (2021). Sarcopenia and Menopause: The Role of Estradiol.

Movement Logic Podcast. Laurel Beversdorf and Sarah Court.

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