Although osteoporosis is widely accepted as an inevitable part of aging, early steps can be taken to avoid it later in life. Due to the effects of perimenopause, women over the age of 50 are four times more likely to develop osteoporosis after menopause.
However, with more understanding of the condition, and what causes it, women can significantly lower the risk of developing it.
What Is Osteoporosis?
In healthy bones, cell activity is continually breaking down old tissue and rebuilding new bone tissue. Known as ‘bone remodeling’, this process occurs throughout life and rebuilds the adult skeleton approximately every 10 years.
After the age of 30, aging tends to slow the process of bone remodeling as oxidated stress in the body increases. An imbalance between antioxidants and free radicals causes oxidated stress, which results in damaged bone cells, reduced bone mass, and eventually osteoporosis.
Essentially, osteoporosis occurs when the development of new tissue is slower than the loss of old bone tissue. This causes the bones to become less dense and weak, enabling them to fracture or break more easily.
Symptoms of Osteoporosis
Due to the lack of obvious symptoms, osteoporosis is often referred to as the ‘silent disease’ and most people don’t know they have it until they break or fracture a bone during a simple fall. That being said, some symptoms can become more evident with age or the early onset of osteoporosis.
These include:
- Back pain (typically due to a collapsed or broken vertebrae)
- A gradual loss of height
- Stooped posture
- Bones breaking or fracturing more easily
Who is At Risk of Getting Osteoporosis?
Research shows that women are far more at risk of getting osteoporosis than men, evident in the fact that of the 10 million Americans currently suffering from osteoporosis, 80% are women. Older Caucasian and Asian women are believed to be more prone than other ethnicities and although older women are more susceptible to osteoporosis, it can occur in younger, premenopausal women too.
The reasons that women are more prone to osteoporosis include the inter-relationship between hormones and bone growth, the fact that women have lighter and thinner bones than men and their life expectancy is typically longer. Women commonly live longer than men and more bone density is lost with aging.
Another factor that contributes to the onset of osteoporosis in women is menopause.
What Is Menopause?
Menopause is considered the end of the reproductive phase of life and is reached when a woman has not had a period for 12 months in a row. Before menopause, women typically go through the menopause transition (perimenopause) for 4-8 years.
Perimenopause usually begins in the late 40s or early 50s as estrogen production declines and the ovaries prepare to shut down. It is during perimenopause that most women start to notice symptoms like mood swings, irregular periods, hot flashes, low libido, heart palpitations, muscle and joint pain, and insomnia.
For most women, menopause is reached between age 51 and 55. Once women reach menopause, they are considered postmenopausal for the remainder of their lives.
Osteoporosis and Menopause: What’s The Connection?
Estrogen largely supports bone health and the process of bone remodeling discussed above. So when estrogen levels begin to decline during perimenopause the process of bone remodeling becomes unbalanced.
As women reach menopause, more bone tissue is typically breaking down than what is rebuilt. This usually continues in the first five years after menopause where women are estimated to lose approximately 10% of their bone mass.
Five years into postmenopause, the loss of bone mass is known to continue but at a slower rate. Even so, 50% of women over the age of 60 are known to experience a bone break or fracture due to osteoporosis.
How Do You Know If You Have Osteoporosis?
The only way to determine if you have osteoporosis is to have a bone density test. Used to measure bone mineral content, bone density tests are performed by X-ray, dual-energy X-ray absorptiometry (DEXA), or a specialized CT scan. These tests can painlessly and accurately identify decreased bone mass and predict the risk of future bone fractures or breaks.
Bone density tests are usually carried out on the spine, hips, and lower arms. A year or two after the first bone density test is performed a second test is typically done to understand if bone density has continued to decline or stayed the same.
Due to the increased risk of osteoporosis in menopausal women, bone density tests are highly recommended for women aged 50 and over. Younger women experiencing frequent bone fractures or bone breaks are also advised to have a bone density test to investigate their bone health and the possibility of early menopause or osteoporosis.
What Contributes to More Rapid Bone Loss in Menopause?
Two things are known to determine women’s chances of getting osteoporosis in menopause – the amount of bone density they have upon reaching menopause and how fast bone density is lost after menopause.
Essentially, the healthier bone density is before perimenopause, and throughout menopause, the lower the chance women have of developing osteoporosis in postmenopause. Therefore, ensuring healthy bone density before estrogen levels decline in perimenopause is equally as important as maintaining healthy bone mass during menopause.
How to Prevent Osteoporosis from Occurring in Menopause?
A combination of healthy lifestyle habits, regular exercise, and beneficial supplements after the age of 30 can help women prevent osteoporosis in their postmenopausal years.
Weight-Bearing & Balance Exercises
Regular exercise enhances muscle and bone strength, and weight-bearing exercises, in particular, are advised to prevent osteoporosis. Walking, hiking, aerobics, dancing, and exercises like push-ups, squats, and lunges are all considered beneficial weight-bearing exercises for improving bone health and decreasing the risk of osteoporosis.
Balancing exercises are recommended to strengthen the muscles, improve equilibrium, and help prevent falls later in life.
Ensure A Healthy Calcium Intake
A healthy calcium intake throughout life is vitally important for bone health and preventing osteoporosis in menopause. The recommended daily intake of calcium for premenopausal women is 1,000 mg per day and postmenopausal women are advised to ensure an intake of 1,200 mg per day.
Low-fat milk and dairy products are considered the best source of calcium but it’s also abundant in foods like broccoli, kale, orange juice, salmon, and sardines. Calcium supplements are recommended for those who don’t consume enough dairy or calcium-rich foods.
Vitamin D
Vitamin D is required to help the body absorb calcium. Although being in the sun for 20 minutes per day can ensure the body makes adequate amounts of vitamin D, women in several parts of the world are vitamin D deficient due to a lack of sunshine for six or more months per year.
It’s possible to increase your vitamin D by consuming egg yolks, liver, mackerel, red meat, salmon, sardines, and plant-based milk. Alternatively, vitamin D supplements are measured with international units (IU), and women are advised to take 600 IU per day.
Sufficient Estrogen
It is widely understood that estrogen is an important hormone for growth during puberty and maintaining a healthy female reproductive system afterward. What most people don’t know is that estrogen is also vital for bone health.
Women who suffer from low estrogen levels before perimenopause are more susceptible to osteoporosis in menopause. It is therefore important to speak with a healthcare provider if you are not menstruating under the age of 40.
Eating disorders, autoimmune diseases, radiation treatment for cancer, excessive exercise, and premature menopause can all affect estrogen production. If you experience any of the above before 40, speak with your doctor about naturally improving estrogen levels with a phytoestrogen like Vitex Chasteberry.
Understanding Medication Implications
Certain medications are known to increase the loss of bone mass. These include but are not limited to anticonvulsants, aromatase inhibitors, blood thinners, steroids, and thyroid medications. Women taking any of these medications are advised to speak with their healthcare provider about reducing their risk of osteoporosis.
Healthy Lifestyle
In addition to eating a well-balanced, nutrient-rich diet, bone health can be maintained and even improved by eliminating poor habits like drinking too much alcohol and smoking.
Excessive or long-term alcohol consumption will not only increase the chances of falling and fracturing bones it also disrupts bone remodeling. Smoking adversely affects the production of estrogen which is essential for bone health.
Treating Osteoporosis in Menopause
Low estrogen levels, genetics, underlying conditions, medication that affects the production of estrogen, and low calcium or vitamin D can all contribute to osteoporosis in menopause. If you are diagnosed with osteoporosis after menopause, the following are recommended for treating it.
- Improve the intake of calcium and vitamin D
- Medication to prevent additional loss of bone density and build new bone mass include bisphonates, denosumab, and selective estrogen receptor modulators (SERMs)
- A hormone called calcitonin, which is usually produced by the thyroid gland can help to regulate calcium and slow the loss of bone mass
- Hormone therapy, particularly estrogen therapy (ET) is often prescribed to treat osteoporosis and other symptoms of menopause. However, ET is also known to increase the risk of breast cancer, heart disease, and blood clots and therefore avoided by many
- Phytoestrogens are a natural, effective, and safe alternative to hormone therapy. Derived from plants instead of animals, phytoestrogens like Vitex Chasteberry can help to improve bone density and promote bone formation without any of the side effects of ET
- Regular weight-bearing and balancing exercises 3-4 times per week can also help treat established osteoporosis. While a sedentary lifestyle and no exercise will promote more bone loss, regular exercise reduces it and improves bone health
What osteoporosis treatments are best will depend on each patient’s age, needs, stage of menopause, and preferences for traditional medicine or natural alternatives. Other factors that healthcare professionals take into consideration when diagnosing treatment for osteoporosis include whether bone breaks have already occurred and the patient’s estimated risk of future fractures.
Conclusion
Osteoporosis is a degenerative bone disease that results in weak, brittle, and easily broken bones. Although it also occurs in men, women are far more prone to osteoporosis due to their life longevity, smaller bones, and lowered estrogen during perimenopause and menopause.
The best way to prevent osteoporosis postmenopause is to ensure adequate calcium, vitamin D, and estrogen levels premenopause and during perimenopause. Regular exercise, limited alcohol, and giving up smoking also help.
If low estrogen levels are contributing to your osteoporosis in menopause, speak with your healthcare provider about the benefits of taking a plant-based phytoestrogen to avoid the unwanted side effects of estrogen therapy.
References
Mayo Clinic – Oseoporosis - https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/
Office on Women’s Health – Osteoporosis - https://www.womenshealth.gov/a-z-topics/osteoporosis
National Center for Biotechnology Information - The Basics of Bone in Health and Disease - https://www.ncbi.nlm.nih.gov/books/NBK45504/
Bone Health and Osteoporosis Foundation – What Women Need to Know - https://www.bonehealthandosteoporosis.org/preventing-fractures/general-facts/what-women-need-to-know/
National Library of Medicine - The Recent Prevalence of Osteoporosis and Low Bone Mass in the United States Based on Bone Mineral Density at the Femoral Neck or Lumbar Spine - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4757905/
National Library of Medicine -The Mechanism of Bone Remodeling After Bone Aging - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8994557/
Johns Hopkins Medicine - Bone Densitometry - https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/bone-densitometry
National Cancer Institute - Menopausal Hormone Therapy and Cancer - https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/mht-fact-sheet
National Library of Medicine - Overview on postmenopausal osteoporosis and periodontitis: The therapeutic potential of phytoestrogens against alveolar bone loss - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9995413/