Bones, Athletes, and the Weird Evolutionary Math of Menopause

Key Takeaways

• ✦A 2026 simulation study argues menopause may have evolved partly because the energy demands of simultaneously supporting older dependent children and aging parents made continued fertility unsustainable — and that stopping reproduction actually helped women survive that crunch.
• ✦A new clinical review finds that female athletes are routinely underserved by sports medicine across their entire lifespan, with perimenopause and menopause largely absent from clinical protocols despite significant impacts on injury risk, recovery, and performance.
• ✦Denosumab is a highly effective bone-density drug, but stopping it can trigger rapid bone loss — sometimes worse than baseline. A 2-year randomized trial published June 29, 2026 found that a single infusion of zoledronate at the time of stopping denosumab substantially prevented that rebound, in both women who had previously taken bisphosphonates and those who hadn't.
• ✦The post-denosumab rebound risk is real enough that discontinuation should never happen without a transition plan — this is a conversation to have with your prescribing doctor before you stop.
• ✦Sports medicine's failure to account for hormonal shifts across a woman's lifespan isn't just a gap in elite athletic care — it affects every active woman trying to stay injury-free in her 40s, 50s, and beyond.