During and after menopause, females tend to have a higher risk of developing osteoporosis. There are ways to slow down and prevent further bone loss, and many treatment options are available once osteoporosis has developed.
As a female enters menopause, their hormones — including estrogen — begin to decrease. Estrogen protects the bone, so it isn’t uncommon for people who are postmenopausal to develop osteoporosis.
Osteoporosis is a disease that causes bone tissue to thin and become less dense. This produces weakened bones that are more susceptible to fracture.
Osteoporosis shows very few symptoms and can progress to advanced stages without presenting any problems. So, doctors often don’t discover it until your weakened bones fracture or break. Once you have a fracture as a result of osteoporosis, you’re more susceptible to another.
These breaks can be debilitating. Most often, doctors don’t discover weakened bones until after a serious fall that results in a broken hip or back. These injuries can leave you with limited or no mobility for several weeks or months. Surgery may also be necessary.
The exact cause of osteoporosis is unknown. However, we do know how the disease develops and what it does to your bones.
Think of your bones as living, growing, and ever-changing entities. Imagine the outer part of your bone as a case. Inside the case is a more delicate bone with little holes, similar to a sponge.
If you develop osteoporosis and your bones begin to weaken, the holes in the inner part of your bone grow larger and more numerous. This causes the internal structure of your bone to weaken and become abnormal.
If you fall when your bones are in this state, they may not be strong enough to sustain the fall, and they’ll fracture. If osteoporosis is severe, fractures can occur even without a fall or other trauma.
Menopause marks the permanent end of monthly periods and fertility. According to the National Institute on Aging, most women start experiencing the changes of menopause between
As a person enters menopause, their estrogen and progesterone levels begin to fall. Estrogen acts as a natural protector and defender of bone strength. Decreased levels of estrogen contribute to the development of osteoporosis.
However, lowered estrogen levels aren’t the only cause of osteoporosis. Other factors may be responsible for weakened bones.
When these factors are in combination with decreased estrogen levels during menopause, osteoporosis may begin or develop faster if it’s already occurring in your bones.
The following are
- Age: Up to around age 30 years, your body creates more bone than you lose. After that, bone deterioration occurs more rapidly than bone creation. The net effect is a gradual loss of bone mass.
- Smoking: Smoking increases your risk for osteoporosis. It
may also cause an earlier onset of menopause, meaning there’s less time for estrogen to protect your bones. Fractures are also more difficult to heal for people who smoke than nonsmokers. - Body composition: Women who are petite or slim have a greater risk of developing osteoporosis than those who are heavier or have a larger frame. This is because smaller women have less bone mass overall compared with larger women. The same is true for men.
- Existing bone density: When you reach menopause, the greater your bone density, the lower your risk of developing osteoporosis. Think of your body as a bank. You spend your young life building or “saving up” bone mass. The more bone mass you have at the start of menopause, the less quickly you’ll “run out.” Encouraging children to build bone density in their younger years is important.
- Family history: If your parents or grandparents had osteoporosis or a fractured hip as a result of a minor fall, you may be at a greater risk for developing osteoporosis.
- Sex: Women are up to
four times more likely to develop osteoporosis than men. This is because women tend to be smaller and usually weigh less than men. Womenover 50 years have the greatest risk of developing the bone disease. - Race and ethnicity: Worldwide, northern Europeans and white people have the greatest risk of fracture due to osteoporosis. Osteoporosis is also decreasing in this population. However, the
Women’s Health Initiative Observational Study showed that there were more fractures due to osteoporosis in African American, Native American, Asian, and Hispanic women than there were cases of invasive breast cancer, stroke, and heart attack death combined in this same population.
Various treatments can help stop the development of osteoporosis. Here are some options:
Ask your doctor about prescription medications and injectable bone-building agents
A group of drugs called bisphosphonates helps prevent bone loss. Over time, these medications slow bone loss, increase bone density, and reduce the risk of bone fractures.
A 2017 study showed bisphosphonates can reduce the rate of fractures due to osteoporosis by
In a study cited by the researchers, 167 participants needed to be treated for 3 years to prevent one hip fracture. Given these circumstances, the relative risk reduction is 36%, whereas the absolute risk reduction is only 0.6%.
Relative risk reduction is the percentage reduction in the rate of fracture in people receiving treatment versus those given a placebo. Absolute risk reduction refers to the proportion of people who are spared from fracture in a specific group as a result of treatment.
Monoclonal antibodies can also help prevent bone loss. These drugs include denosumab and romosozumab (Evenity). They are targeted at females at particularly high risk of fractures.
Other medications include:
- calcitonin
- estrogen
- teriparatide
- abaloparatide
Among these medications, doctors frequently prescribe teriparatide and abaloparatide to help people reduce their incidence of osteoporotic fractures. These anabolic medications work by stimulating new bone formation rather than reducing bone loss as in the case of the other medications.
Menopausal hormone therapy
Menopausal hormone therapy (MHT), or hormone replacement therapy (HRT), can help prevent bone loss caused by the decreased level of estrogen that occurs during perimenopause and menopause. However, experts currently recommend HRT only after considering other options for bone health.
HRT may have a role when treating other symptoms of menopause, including hot flashes, night sweats, and changes in mood. However, this therapy isn’t for everyone. It may not be the correct treatment option if you have a personal history of or are at an increased risk for:
Selective estrogen receptor modulators, or SERMs, are a group of drugs that have estrogen-like properties. Doctors sometimes use these for the prevention and treatment of osteoporosis.
SERMs may consist of estrogens alone or in combination with progestin. Doctors commonly prescribe the following SERMs:
- raloxifene
- bazedoxifene
- tibolone
- bazedoxifene combined with conjugated equine estrogen
Studies have shown that these medications can slow bone turnover and increase bone mineral density (BMD) in early and late postmenopausal women.
Raloxifene is a common treatment to help prevent osteoporosis postmenopause. Research has found it to be effective in treating osteoporosis and decreasing the risk of spinal fractures among those with a high risk of breast cancer. However, it is ineffective against nonspinal fractures.
When making treatment decisions, it’s important to consider potential risks for cardiovascular and kidney diseases, and other co-existing medical conditions. Talk with your doctor for more information about this treatment option.
Prevention is always more effective than cure. Here are some steps you can take to reduce your risk of osteoporosis and to help prevent bone deterioration:
Take calcium and vitamin D supplements
Calcium can help build strong bones and keep them strong as you age. The
- People ages 19 to 50 years: 1,000 milligrams (mg) of calcium each day
- Females over 50 years and all adults over 70: at least 1,200 mg of calcium each day
If you can’t get adequate calcium through food sources like dairy products, kale, and broccoli, talk with your doctor about supplements. Both calcium carbonate and calcium citrate deliver good forms of calcium to your body.
Vitamin D is important for healthy bones, as your body can’t properly absorb calcium without it. Fatty fishes such as salmon or mackerel are good sources of vitamin D from food, along with foods like milk and cereals that contain added vitamin D.
Sun exposure is the natural way the body makes vitamin D. But the time it takes for the sun to produce vitamin D varies depending on the time of day, the environment, where you live, and the natural pigment of your skin.
Supplements are available for people concerned about skin cancer or who wish to get their vitamin D in other ways. The
- People ages 19 to 70 years: at least 600 international units (IU) of vitamin D every day
- People 71 years and above: 800 IU of vitamin D every day
Make weight-bearing exercise part of your fitness routine
Exercise often does as much to build and maintain strong bones as medication does. It strengthens bones, helps prevent bone loss, and speeds up recovery in the event of a bone fracture.
Walking, jogging, dancing, and aerobics are all good forms of weight-bearing exercise. A 2017 study indicates that swimming and water-based exercises also provide some benefit to bone strength but not as much as weight-bearing activities.
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People going through menopause are at a higher risk of developing osteoporosis, but there are many ways to slow the process and fortify your body against it. Taking calcium and vitamin D supplements and including weight-bearing exercise as part of your fitness routine can help prevent bone deterioration.
If you have already developed osteoporosis, discuss the different suitable treatment options with your doctor. While some medications work for others, it may not work for you. It’s important to consider whether a medication can lead to side effects and complications due to your unique physiology.