Why Bone Loss Accelerates During Perimenopause: The Role of Insulin Resistance and Hormones

Research indicates that osteoporosis may be made worse by Insulin resistance

When we think of insulin resistance, most of us associate it with blood sugar imbalances, prediabetes, or type 2 diabetes. But fewer people realize that insulin resistance can silently weaken our bones — setting the stage for osteoporosis, particularly during the hormonal shifts of menopause.

What Is Insulin Resistance?

Insulin is a hormone that helps your cells absorb glucose from your bloodstream to use as energy. When your body becomes insulin resistant, your cells don’t respond properly to insulin, so your pancreas has to pump out more to get the job done. Over time, this can lead to chronically high insulin and blood sugar levels.

How Insulin Resistance Affects Your Bones

Bones are dynamic living tissues — constantly being broken down and rebuilt. The process depends on a delicate balance between osteoclasts (cells that break down bone) and osteoblasts (cells that build new bone).

Here’s how insulin resistance can interfere with this balance:

Reduced Osteoblast Activity

Insulin is actually anabolic for bones — meaning it stimulates bone formation. But when cells become resistant to insulin, osteoblasts stop responding properly. This slows down bone building.

Increased Inflammation

Insulin resistance promotes chronic low-grade inflammation, which stimulates osteoclasts to break down bone more rapidly — and hinders the repair process.

Disrupted Calcium Metabolism

High insulin and glucose levels can interfere with how your kidneys and bones handle calcium and vitamin D — both essential for strong bones.

Higher Risk of Falls

Insulin resistance is also linked to muscle loss, fatigue, and balance issues, increasing the risk of falls and fractures.

Even before blood sugar issues show up on lab tests, insulin resistance can quietly set the stage for osteoporosis.

Bone Loss Speeds Up During Late Perimenopause and Early Menopause

Women naturally begin to lose bone mass after about age 35, but the process dramatically accelerates during late perimenopause and the early years of menopause. Here's why:

1. Estrogen Drops — Fast

Estrogen isn’t just a reproductive hormone; it’s a major player in bone health. It keeps osteoclast activity in check. When estrogen declines rapidly in the late stages of perimenopause, bone breakdown speeds up — often faster than your body can rebuild.

2. Progesterone Plays a Role Too

Progesterone, which declines earlier than estrogen, supports osteoblasts (the bone-building cells). So the earlier stages of perimenopause may already start weakening your bones.

3. Bone Loss Can Be Steep and Silent

On average, women lose up to 20% of their bone density in the 5–7 years after menopause — often without any symptoms until a fracture occurs.

4. Insulin Resistance Makes It Worse

The metabolic changes that happen around menopause — weight gain around the middle, fatigue, brain fog — often reflect growing insulin resistance. Combined with hormone loss, this becomes a “perfect storm” for accelerated bone weakening.

What You Can Do to Protect Your Bones (and Balance Insulin)

Prioritize Protein and Minerals

Make sure your diet includes enough protein, magnesium, calcium, and vitamin D3/K2 to nourish your bones and muscles.

Stabilize Blood Sugar

Avoid refined carbs and sugar spikes. Eat fiber-rich whole foods and balanced meals to keep insulin levels in check.

Strength Train Regularly

Resistance exercise is one of the best ways to signal your body to build both muscle and bone — and it improves insulin sensitivity.

Reduce Inflammation

Support gut health, manage stress, and consider anti-inflammatory herbs like turmeric, ginger, or nettle leaf in your diet. These are great in teas. Follow a traditional mediterranean diet.

If you’re in your 40s or 50s and noticing weight gain, fatigue, or irregular periods, this is a crucial time to act. Insulin resistance and hormone changes often arrive together — and together, they can accelerate bone loss. The good news? With the right strategies, you can slow or even reverse this process.

Protecting your bones starts with balancing your blood sugar and honoring your hormonal shifts. Your future self will thank you.