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Menopause and Osteoporosis

Osteoporosis is when your bones become weak and are more likely to fracture. Women are at a higher risk of developing this condition than men, and the risk increases with menopause. Here, we explain what Osteoporosis is and how to keep your bones strong and healthy.

What is Osteoporosis?

Osteoporosis is a full body, skeletal disorder where your bones become weaker. They change in structure and begin to thin - becoming more fragile. It can make you more prone to fractures, usually in your hips or lower back. Unfortunately, this disease often progresses without any obvious symptoms or pain - meaning many people are unaware of having the condition.

Who typically gets Osteoporosis?

Generally, your risk of osteoporosis increases with age. A big factor in this is an overall decrease in physical activity. Muscle protects your bones. If you stop using and building your muscle you'll lose this protective layer. To put it simply, if you don’t use it, you lose it.

There's also a genetic component. So if your mother or grandmother shrank in height dramatically as she aged, or was known to have Osteoporotic vertebral (backbone) fractures, then you're at an increased risk.

The risk of Osteoporosis also increases as women go through menopause. Oestrogen levels dropping changes the structure of our bones and can cause them to weaken. Sadly, up to to 40% of postmenopausal women will suffer at least one osteoporotic fracture in their life. So our bone health is really important.

Oestrogen plays a major role in our bone health, and as we know, it drops as we go through menopause. Postmenopausal women are actually at a 10x more risk of a fracture than men.

Throughout our life, our bones are continuously being ‘remodelled’. This means that they are constantly being broken down (bone resorption) and renewed (bone formation). Before we reach our peak bone mass, between ages 20-30, bone formation outpaces bone breakdown so that our bones can adapt to support our growth and development.

Oestrogen plays an important role in this process because it is able to promote bone formation whilst simultaneously slowing down bone resorption (break down). This ensures that our bones are maintaining their structure and strength. During menopause, however, our oestrogen levels reduce and our overall bone growth will begin to slow. Falling levels of oestrogen ultimately mean that our bodies are no longer able to promote bone formation. This means that more bone will get broken down, and not replaced. Leading to thinner and weaker bones.

How is Osteoporosis risk different in women with Premature Ovarian Insufficiency (POI) or Early Menopause?

For most women, menopause will happen between the ages of 45-55. Some women experience early menopause (40-45) or develop premature menopause (under 40). With POI or early menopause can come typical menopausal symptoms. Unfortunately, oestrogen levels dropping early also increases your risk of a fracture. This is because your oestrogen levels are changing earlier in life, upsetting your bone structure and causing them too thin at a younger age.

If you're experiencing menopausal symptoms early (under 40) or are concerned about your bone health you should speak with a doctor. They can help you to explore the preventative measures you can take, and work towards strengthening your bones.

Osteoporosis and HRT

HRT is really effective at controlling symptoms and reducing the risk of osteoporotic fractures. However, HRT alone is not usually recommended as a first line treatment for people at risk of osteoporosis. This is because the protective effect of HRT quickly falls after therapy is stopped, making it only a temporary solution. A combination of HRT and lifestyle changes, such as increased physical activity, has also been shown to improve bone strength.

Not all women can take HRT and not all women want to. There are diet and lifestyle changes which can really help.

Diagnosis and drug treatments for Osteoporosis are discussed in our article 'Osteoporosis Risk and Medication'.

Lifestyle Changes

Bone growth is stimulated by weight bearing physical activities. Being inactive can accelerate your risk of developing Osteoporosis. Resistance training is a great way to build up your bone mass and muscles. Additionally, building up your muscles through weight bearing activities can help you create a protective layer of muscle. By staying active at least 4 times a week, you are strengthening your bones and reducing your risk of unexpected breaks.

Weight bearing exercises are any activities done on your feet. This includes exercises such as walking, running, cycling and yoga.

Dietary Tips

Dietary Calcium is an important regulator of our bone composition. 99% of the calcium that we have in our body’s live in our bones and teeth, contributing to their overall strength and structure. Our bodies cannot make calcium though, so we must make sure that we are getting enough through our diet. If we do not eat enough of it and our calcium levels are low, our body will begin stealing it from our bones. If this happens over a long period of time it can make our bones thin and weak.

This makes calcium in the diet all the more important! Dairy products such as milk, cheese and yoghurt are all excellent sources of calcium. Luckily, calcium is present in a wide range of foods, here are some resources which can help you include it in your diet.

In addition to calcium, vitamin D is an essential vitamin that is readily available and very important in promoting bone formation. Public Health England advises all adults to have 10 micrograms of vitamin D a day. The best sources of vitamin D include the sun and a variety of foods, such as fatty fish and nuts. Our bodies are actually able to use sun exposure as a way to internally create vitamin D. If, however, you find yourself to have minimal sun exposure on a daily basis, supplements are a safe and alternative option which can help you get your daily requirements!

Vitamin D supplements are made in a variety of forms and are well tolerated by most people. Visit the NHS to learn more about the importance of vitamin D and the different supplements available to you. Supplements are especially recommended amongst men and women who are at increased fracture risk, such as during and after menopause. If you think you may be at increased risk, have a look our 'Diagnosis and Treatment of Osteoporosis' article to learn more about that steps you can take to asses your bone health.

If you prefer to stay away from dairy and/or fish, stalk up on some leafy greens such as kale, mustard greens and brussel sprouts. They are packed with calcium and vitamin D. Try and incorporate these greens into every meal so you're supporting your bones. Additionally, fortified milks, such as soy or almond, also contain considerable amounts of calcium and vitamin D.

Understand, however, that alternative milks and leafy greens are not the most effective sources of Calcium or Vitamin D. If you are vegan or vegetarian, it is worth checking your diet with an expert source such as the British Dietetic Association to ensure you are getting enough of both to support your bones.

References

Bda.uk.com. n.d. Plant-Based Diet. [online]
Available at: https://www.bda.uk.com/resource/plant-based-diet.html [Accessed 11 May 2020].

Bda.uk.com. n.d. Calcium. [online]
Available at: https://www.bda.uk.com/resource/calcium.html [Accessed 11 May 2020].

Bda.uk.com. n.d. Vitamin D. [online]
Available at: https://www.bda.uk.com/resource/vitamin-d.html [Accessed 8 May 2020].

nhs.uk. 2020. The NHS Website. [online]
Available at: https://www.nhs.uk

National Osteoporosis Foundation. 2020. What Women Need To Know - National Osteoporosis Foundation. [online]
Available at: https://www.nof.org/preventing-fractures/general-facts/what-women-need-to-know/ [Accessed 4 May 2020].

Menopause.org.au. 2018. Osteoporosis - Australasian Menopause Society. [online]
Available at: https://www.menopause.org.au/hp/information-sheets/622-osteoporosis [Accessed 4 May 2020].