Menopause and Osteoporosis: Keeping Bones Healthy | Stella
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Bone health: Your questions answered about Osteoporosis and menopause

byDr Michelle Griffin

You may have heard of osteoporosis and the related condition, osteopenia. They affect your bones and increases the risk of fractures. Both become much more common in perimenopause and beyond. What can you do to protect your bones and to make sure that they stay strong and healthy for years to come? Read on to find out more about osteoporosis and menopause.

What is osteoporosis?

Osteoporosis is commonly referred to as ‘thinning of the bones’. This means that bones become weaker and more prone to breaking. You may also hear the word osteopenia. This condition is also due to thinning of the bones, but is not as severe as osteoporosis.

Both are said to be ‘silent’ conditions as they often cause no symptoms and can remain undetected until the sufferer breaks a bone. This is why it’s important that you are aware of the risk and start protecting your bones as early as possible.

How does osteoporosis cause problems?

The main problem is that it becomes much easier for you to break bones, even sustaining fractures due to very minor injuries.

As the bones in the spinal column are often affected by osteoporosis, we commonly see fractures in the small bones which make up our spine (the vertebrae). These can, in turn, cause trapped nerves and even nerve damage in some cases. Likewise, damage to the spine can also cause stooped posture and mobility problems. Don’t panic, there are things you can do about osteoporosis and menopause, which we will share later on.

How common is it?

Osteoporosis is very common, particularly as we age – 70% of people aged over 80 are affected. It’s likely you probably know a few people with osteoporosis already. One study found that it affects up to 38% of women over the age of 50, or menopausal age.

Men are also affected, but to a lesser extent – the same study found that up to 8% of men have the condition.

Why is osteoporosis more common after menopause?

Surprise! The reason osteoporosis and menopause can be linked is all down to the hormone oestrogen. Many people see bones as unchanging, ‘dead’ tissue. The truth is far from it! 

Just like any other part of the body, the tissue which makes up our bones is constantly changing and remodelling itself. This allows the bones to remain strong, and to adapt to any new strain placed on the body, such as manual work or lifting heavy weights. 

Did you know, up to 10% of your bone mass is replaced each and every year? This renewal happens thanks to the activity of two different types of cells – osteoblasts and osteoclasts. Osteoblasts are responsible for building new bone where it is needed, while osteoclasts break down damaged areas.

Both of these cell types are stimulated by oestrogen, leading to a healthy turnover of bone. However, since our bodies make less oestrogen after menopause, their activity levels decrease. This leads to a change in the bone structure and, ultimately, thinning and weakness, hence the link between osteoporosis and menopause.

What makes osteoporosis more likely?

There are certain risk factors which can increase your chance of developing osteoporosis. These fall into two categories: modifiable (you can take steps to change them) and non-modifiable ( you cannot change them).

Non-modifiable risk factors

  • Being female 
  • Going through menopause – although some women take hormone replacement therapy, which can help preserve bone density. This equally applies if you have gone through menopause due to surgical removal of your ovaries
  • Your ethnic group – people of European and Asian descent are more prone to osteoporosis than other ethnicities
  • Your genetics. Osteoporosis and fragility fractures are known to run in families
  • Some medications – including certain antiepileptics, chemotherapy, stomach ulcer/indigestion medication called proton pump inhibitors and steroids, many of which cannot be stopped for medical reasons
  • Some medical conditions – including anorexia, hyperthyroidism, previous fractures and some types of kidney disease
  • Your build. Smaller women tend to have a higher risk of osteoporosis

Modifiable risk factors

  • Smoking
  • Drinking alcohol
  • Vitamin D deficiency
  • Taking too little exercise
  • Endurance training
  • Being underweight
  • Certain medications

How can I reduce my risk?

There are many ways in which you can reduce your risk of osteoporosis:

  1. Stop smoking. Research shows that quitting has a positive effect on bone density and markedly reduces your risk of osteoporosis. Stopping smoking also has benefits for your overall health, including reducing your risk of cancer, lung disease, heart disease and dementia
  2. Watch your alcohol intake. One study showed that drinking more than three units per day increases your risk of fractures, but drinking at levels lower than this can actually increase bone density. However, that does not mean that you should rush out and buy a bottle of fizz! Alcohol is known to be linked to an increased risk of other health problems, even at low levels. This is especially important for women going through menopause, as alcohol can worsen a number of menopausal symptoms including hot flushes, mental health issues and poor quality sleep. Generally, the less you drink the better
  3. Have a healthy, balanced diet. Calcium is often mentioned when talking about nutrients for bone health, but the evidence on whether it actually helps is mixed. The ideal diet to promote good bone density includes plenty of protein, vitamins and minerals. This naturally includes sources of calcium, but no specific supplement is needed unless recommended by your doctor
  4. Make sure you are getting enough vitamin D. Vitamin D is found in certain foods, and is also produced by the skin in response to sunlight. It is vital for bone health as it affects parathyroid hormone, which is partly responsible for controlling bone density. Many women who live in northern regions (including the UK and parts of North America) are deficient in vitamin D due to low levels of sunlight in these areas. Dietary sources include egg yolks, oily fish, red meat and liver, as well as certain fortified foods including breakfast cereals. Many people choose to take a vitamin D supplement in order to boost their vitamin D levels, especially in the less sunny winter months. These are easily available from pharmacies and health food stores
  5. Maintain a healthy weight. Being underweight is a known risk factor of osteoporosis. Speak to your doctor if you are struggling to gain weight
  6. Incorporate exercise into your routine. Weight bearing exercise, also known as strength training, is an especially good way to boost your bone density. This includes brisk walking, running, dancing and many others. Women who undertake intense endurance training (for example, long distance running) can be at a higher risk of developing osteoporosis, so moderation is key. Find out more about aches and pains during menopause with our symptoms guide.

Should my doctor be screening me for osteoporosis?

In the UK, it is recommended that all women aged over 65 (and men over 75) should be assessed for their risk of fragility fractures. People in other age groups should also be assessed if they have certain risk factors, including steroid use, menopause before age 40, diabetes, coeliac disease and inflammatory bowel disease among others.

If you have any of these, your doctor can use a calculator called QFracture or FRAX to find out your chance of having a fragility fracture within the next 10 years. If this is over a certain level, they may refer you for a DXA scan – a type of x-ray that can accurately measure your bone density.

Are there any treatments for osteoporosis?

Yes there are. If you are at high risk of a fragility fracture, your doctor may advise taking medication to boost your bone density. These include:

  • Bisphosphonates, including the commonly-used alendronate and risedronate. They are taken as either daily or weekly tablets. If you are unable to take these for any reason, you may be referred to a specialist to explore other options
  • Vitamin D or calcium supplements may be prescribed if needed
  • Hormone replacement therapy (HRT). This is known to improve bone density as well as other menopausal symptoms in women who are in perimenopause and beyond. Learn more about the HRT debate.

What exercises improve your bone density? 

You can begin by making a gradual start. Try it out the next time you are making a cup of tea or coffee at work or at home. Do this regularly and you can start maintaining your bone health. 

1 – Calf raises

Do 12 repetitions three times (12 x 3).  You can do this as the kettle boils.

2 – Side lunge

Do two sets of eight repetitions (2 x 8) – you can do this while the tea is brewing. This exercise is a great start on trunk control and it can improve posture and back pain too!

3 – Step ups

Do this for two minutes consecutively. You can interchange this time-based exercise with either of the others. This exercise has the added benefit of increasing your aerobic fitness, getting your heart pumping. You can easily modify this and do marching on the spot.

Find out more about the stages of menopause on our blog or find out more in our symptoms library.