The aim of the present study was to investigate the association between grip strength change and bone health according to menopausal status. A random sample of 971 pre- to postmenopausal women from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study cohort was measured with dual X-ray absorptiometry in the lumbar spine (LS) and femoral neck (FN) and grip strength with pneumatic squeeze dynamometer at baseline (1989-1991), 5 years (1994-1997), and 10 years (1999-2001). Fractures were recorded based on self-reports and validated from medical records. Women were divided into two groups according to change in grip strength quartile from baseline to 5-year follow-up: not improved (n = 735) and improved (n = 236). In the total population, the greatest bone loss was observed in perimenopausal (beginning of menopause during follow-up, n = 311) women [P < 0.001 vs. premenopausal women (n = 139)], and it declined in postmenopausal (n = 521) women [P < 0.001 by analysis of covariance (ANCOVA)]. The perimenopausal bone loss rate was significantly lower in women in the improved group in comparison to the not improved group (P < 0.01) in contrast to the pre- and postmenopausal groups (P > 0.05). Accordingly, there was a greater decline in perimenopausal LS and FN T-scores in the improved group vs. the not improved group over the first 5-year follow-up interval (P < 0.05 by ANCOVA) and remained unchanged over the 10-year follow-up. In perimenopausal women, there was a trend toward higher fracture-free survival rate in the improved group (82%) vs. the not improved group (88%) after 10 years. Adjustments did not change the results. In conclusion, maintenance of grip strength is associated with menopausal bone loss and future fractures.