Bone Loss: The Menopause Side-Effect No One Is Talking About

When we think about menopause, hot flashes and vaginal dryness are usually what come to mind. But changing hormone levels have far-reaching impacts that we can feel deep in our bones (literally). Yes, menopause has an important influence on bone health, and it’s high time we start talking about it. So you have the info you need to prevent fractures later in life.

In this post, we’ll break down the link between menopause and osteoporosis and give you expert tips to keep your bones happy and healthy well into your golden years.

What Happens to Our Bones as We Age?

Bones are dynamic, living tissues that constantly renew themselves. Whenever you move, your muscles tug on your bones, which stimulates them and keeps them strong.

But as we age, muscle mass and strength gradually go down (it happens to all of us). This means there’s less pulling on the bones, disrupting the normal bone remodeling process. Weaker muscles inevitably cause weaker bones.

Why Estrogen Matters For Bone Health

Estrogen isn’t just important for reproductive health. It’s also a key player in maintaining strong bones.

That’s why the bones take a hit in menopause. Here’s what happens:

• Bone loss speeds up: Lower estrogen increases inflammatory chemicals in the body which break down old bone faster.
  
  

• Bone building slows down: These same chemicals hinder the formation of new bone.

Medically-induced menopause (caused by treatments like chemotherapy or surgery) can cause even more rapid bone loss due to the sudden drop in estrogen levels.

The Timeline of Bone Loss

Bone loss doesn’t wait until menopause to begin. It starts in the 3-5 years leading up to it – this period is called perimenopause. You can learn all about perimenopause and menopause in this article.

The first year after your final period is generally the biggest for bone loss.

The good news? It doesn’t last forever. Around 5 years after the onset of menopause, bone metabolism begins to stabilize. But by then, damage may already be done, so early prevention is key.

The Stages of Bone Loss: Osteopenia vs. Osteoporosis

Osteoporosis doesn’t happen all of a sudden. It’s a gradual process. The early stage of bone thinning is known as osteopenia. Think of it as a warning sign that bone density is low. But if you take action, you can stop it from turning into osteoporosis.

Osteoporosis is more severe bone loss. The term comes from Greek and literally translates to “porous bone”. It means that the bones have become brittle and prone to fractures. If you were to look at a bone from a person with osteoporosis under a microscope, it would look like a honeycomb with broken links between the cells.

Osteoporosis increases the likelihood of breaking a bone – even from a minor fall when in a standing position. With serious osteoporosis, even something as small as a sneeze could break a bone.

While both men and women can develop osteoporosis, it’s much more common in women due to the link to estrogen. About 1 in 2 postmenopausal women break a bone due to this condition.

Risk Factors for Bone Loss

Certain things make it more likely that someone will develop osteopenia or osteoporosis.

These include:

• Smoking

• Sedentary lifestyle

• Early menopause

• Low vitamin D levels

• Kidney or liver disease

• Very low weight or malnutrition

• Being critically ill or bedridden

• Prior non-traumatic fractures

• Drinking more than 1 alcoholic beverage daily

• Family history of osteoporosis or broken hips

• Inflammatory conditions like rheumatoid arthritis, ulcerative colitis, lupus, Crohn's disease, cancer, COPD, diabetes, or obesity

• Prior bariatric surgery (or another surgery that affects how you absorb nutrients)

• Certain medications for seizures, cancer, thyroid disorders, or chronic obstructive pulmonary disease (COPD)

• High doses of steroids (prednisone) over a long period

While certain factors aren’t in your control, lifestyle habits have a big influence on bone strength. By leading a healthy life through nutrition and exercise, you can significantly reduce your risk. Next, we’ll explore how.

Prevention and Early Detection of Osteoporosis

Nutrients that build strong bones

Calcium and vitamin D are somewhat of a dream team when it comes to bone health.

Calcium builds bones, and vitamin D helps your body absorb the calcium that you take in. Together, they form the foundation of strong bones.

According to the Bone Health and Osteoporosis Foundation, menopausal women should have 1,200 mg of calcium each day.

Good sources of calcium include dairy products, fortified plant-based milks, leafy greens (like kale and broccoli), and canned fish with bones.

Your body produces vitamin D naturally when you spend time in the sun. Getting 15 minutes of direct sunlight daily is generally enough to meet your daily requirements.

Vitamin D is also available in certain foods, including fatty fish (salmon, tuna), egg yolks, mushrooms, and fortified dairy products.

It’s best to get your daily fill of these nutrients through food and the sun. But if you’re worried you’re not getting enough from your diet, it’s a good idea to speak to your doctor about supplementation. As for vitamin D, for most people just 1000-2000 IU/day will be plenty.

Exercises For Bone Strength

When it comes to bone health, not all workouts are created equal. For instance, aerobic activities like swimming or cycling – while they bring other health benefits – don’t do much to support your bones.

If you’re specifically looking to give your bones a boost, experts say to focus on:

• Weight-bearing activities: Walking, jogging, or stair climbing.

• Strength training: Lifting weights or doing bodyweight exercises to build muscle and stimulate bone growth.

• Balance: Practicing yoga or tai chi can improve your balance and may help prevent falls which could lead to fractures.

If you already have osteoporosis, talk to a doctor or physical therapist before starting a new exercise routine to ensure it’s safe and avoid injury.

Other Lifestyle Changes For Healthy Bones

Here are a few final expert tips to support your bone health as you age:

• Quit smoking: Smoking is a double whammy for bone loss. Nicotine in cigarettes slows down the bone formation process, and tobacco decreases calcium absorption.

• Eat an anti-inflammatory diet: The Mediterranean diet, which is full of fruits, vegetables, lean proteins, and healthy fats, lowers the risk of chronic disease and supports bone health.

• Stay active: Try your best to avoid staying seated for too long, because this weakens the bones. Instead, aim to incorporate movement into your daily life with regular aerobic, weight-bearing, and strength training exercises. Happy muscles mean happy bones!

Screening and Early Detection

Doctors assess bone density with a test called a DEXA scan. Medical societies recommend that all women discuss screening with their doctors when they reach 50, and screening generally happens every 2 years.

However, if you have any risk factors for osteopenia and osteoporosis, it’s recommended to have the conversation even earlier so you can ahead of things.

This scan measures your T-score – a number that compares your bone density to that of a young, healthy adult. A T-score BETWEEN -1.0 and -2.5 signal osteopenia. -2.5 and worse is osteoporosis.

Treatment Options for Bone Loss

If you are in perimenopause or menopause it is important to ensure you’re meeting your body’s nutritional needs for calcium and vitamin D and staying active with weight-bearing exercises.

Different medications are available to both help your body build new bone and slow down the bone loss process. Evidence shows that it’s best to start with bone-building medications for the best results. alendronate is the most commonly prescribed medication as it’s effective, inexpensive, and easy to take.

Now you may be wondering – since hormones are so important for bone health – which hormonal medications are available.

No official medical guidelines indicate HRT as a primary osteoporosis treatment, but they do acknowledge bone building benefits of HRT and advocate for it as adjunctive therapy when it’s used properly in appropriately selected patients.

If you’re entering perimenopause and experiencing symptoms, experts recommend speaking to your doctor about the risks and benefits of HRT. Note that testosterone-specific therapy is not recommended by endocrinologists as a treatment for bone loss.

Takeaway

Changes in muscle mass and bone density may be a natural part of getting older, but there’s a lot you can do to take control of your bone health in menopause.

With a healthy, anti-inflammatory diet and active lifestyle, you can prevent osteoporosis and fractures. So get moving, load up your plate with leafy greens, and soak up the sun – your bones will thank you later!

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