Menopause and Osteoporosis: Keeping Bones Healthy | Stella
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Osteoporosis and bone health in menopause

byDr Emily Simon

As you get older, your risk of breaking bones increases. Why does this happen and what has menopause got to do with it? Dr Emily Simon, a doctor with a special interest in women’s health, explains how bones become weaker and stronger, and what you can do to keep them healthy.

What happens to your bones as you age?

Bones provide the framework on which the whole body hangs and are super important to your wellbeing.

There are two types of cells that are important for your bones:

  • Osteoblasts. These help to make new bone. When you are younger osteoblast activity is greater but as you get older these cells function less well
  • Osteoclasts. On the other hand osteoclasts break down old bone. Their activity increases as you get older

What does this mean? Quite simply that your bones get thinner, weaker, less dense and are more likely to break as you age. 

What is osteoporosis?

When your bones lose some of their bone density, we call that condition osteopenia. It means that our bones have become thinner, but they are not yet at risk of breaking.

If you continue to lose more of that bone mass then your bones become vulnerable to breaking, known as osteoporosis

You often don’t know what is happening to your bone mass and have no idea of the strength or weakness of your bones until they break. Most people with thinning of the bones aren’t aware of the problem until they have a fracture.

Osteoporosis causes bones to break without much pressure at all. When you are young, and you fall over or bump into something you are unlikely to break a bone. Once osteoporosis sets in, even a very minor injury can cause a fracture. These are called fragility fractures and occur because your bones are more fragile, and less hardy.

As osteoporosis progresses, the small bones in your spine can lose density and they can start to break. This leads to pain in the back and curving of the spine.

Once osteoporosis sets in, even a very minor injury can cause a fracture.

Once osteoporosis sets in, even a very minor injury can cause a fracture.”

How common is osteoporosis?

It is surprisingly common. Studies show that 1 in 3 women over the age of 50 will experience a fracture due to osteoporosis in their lifetime. For men, it’s more likely to be 1 in 5.

Is osteoporosis linked to menopause?

Yup, you guessed it! Oestrogen, your lovely female hormone, has a massive role to play in bone health. This is because it promotes the activity of osteoblasts (our bone-building cells). Without oestrogen, your osteoblast activity declines and then you don’t lay down or make as much new healthy bone.

What increases my risk of getting osteoporosis?

Risk factors beyond your control

  • Ageing – this plays the biggest role
  • Your family history – if your mum, grandma and sisters have osteoporosis, you are more likely to get it 
  • Being petite or having a small build can increase your chances 
  • Certain medical conditions (such as hypothyroidism and diabetes) and certain drugs can increase your risk, such as steroids
  • Needing to be on bed rest for long periods

Risk factors in your control

  • Smoking 
  • Being underweight or having a BMI of 19 or less
  • Not exercising
  • Drinking excessive alcohol
  • Eating a low-calcium diet and not getting enough vitamin D

Calcium and vitamin D – what’s the connection?

Calcium is needed to help build and maintain bones and vitamin D helps your body effectively absorb calcium and get it to where it’s needed. Both are essential for strong bones.

How can you improve your bone health?

  • Stop smoking. Quitting has a positive effect on your 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
  • Watch your alcohol intake.  Drinking more than 2 units of alcohol per day (a glass of wine is two units as is one shot of gin!) increases your risk of fractures. Alcohol can also worsen a number of other menopause symptoms including hot flushes, mental health issues and poor-quality sleep. The less you drink, the better
  • Have a healthy, balanced diet. The ideal diet to promote good bone density includes lots of protein, vitamins and minerals. Eating three meals a day with lots of fruit and veg, and making sure you are not calcium deficient, will help to protect your bones
  • Make sure you are getting enough vitamin D.  We get vitamin D from sunlight and from our diet. Dietary sources of vitamin D include egg yolks, oily fish, red meat and liver, as well as certain fortified foods including breakfast cereals. At the end of a British winter, it is quite common to be low in vitamin D and many people choose to take a daily supplement especially during these months. These can be bought over the counter at pharmacies and supermarkets
  • Maintain a healthy weight. Being underweight is a known risk factor of osteoporosis. Speak to your doctor if you are struggling to gain weight
  • Incorporate exercise into your routine. Weight-bearing exercise, also known as strength training, is an especially good way to boost your bone density. Muscles are attached to bones and strong muscles promote strong bones. Exercises such as Pilates, swimming, brisk walking, running and dancing can really help

How do you test for osteoporosis?

The way we test is by doing a specific type of X-ray called a DEXA scan. This looks at the bones in your hip and your spine and calculates your bone mass density.

Should your doctor screen you for osteoporosis?

Testing is recommended for people who are considered to be at high risk of osteoporosis, including:

  • People with a strong family history of osteoporosis
  • Those who have gone through early menopause
  • People on long-term steroid use
  • Those with low weight/body mass index, and certain medical conditions

In the UK, women over the age of 65 can be screened for their risk of having a fragility fracture. If they fall into a higher risk category, they will be referred for a DEXA scan.

Sometimes, on a normal X-ray, bone thinning can be seen, and if that is the case, then you will also be recommended to have a DEXA.

Are there any treatments for osteoporosis?

Yes, there are. As well as all the lifestyle measures discussed above, if you have osteoporosis, your doctor may advise taking medication to boost your bone density. These include:

  • Bisphosphonates, e.g. Alendronate and Risedronate. They reduce the activity of osteoclasts and therefore bone is broken down more slowly. They are taken as either daily or weekly tablets 
  • Vitamin D and/or calcium supplements may be recommended
  • Hormone replacement therapy (HRT). Oestrogen is known to improve bone density and so taking HRT (oestrogen) can help to protect your bones. Ongoing studies are looking at HRT use for women who are at high risk of osteoporosis, even if they don’t have menopausal symptoms

Find out more about the risks and benefits of HRT.

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.

Final word

Osteoporosis is a condition when your bones become thin and are therefore more likely to break. It happens as you get older. Oestrogen plays an important role in promoting healthy bones.There are lots of lifestyle measures you can do to protect your bones and reduce the risk of osteoporosis. If you are at high risk for bone fractures, HRT may play an important role in protecting your bones.