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Osteoporosis, Bone Health, and Menopause

Medically reviewed by Judith Marcin, MD on October 10, 2017Written by Kimberly Holland

What is 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 it’s often not discovered 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, your weakened bones aren’t discovered until after a catastrophic 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 required for treatment.

How does osteoporosis develop?

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 of your body. Imagine the outer part of your bone as a case. Inside the case is a more delicate bone with little holes in it, 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.

Osteoporosis and menopause

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 the ages of 45 and 55.

As women enter menopause, their estrogen and progesterone levels begin to fall. Estrogen acts as a natural protector and defender of bone strength. The lack of estrogen contributes to the development of osteoporosis.

Decreased estrogen levels aren’t the only cause for osteoporosis. Other factors may be responsible for weakened bones. When these factors are combined with decreased estrogen levels during menopause, osteoporosis may begin or develop faster if it’s already occurring in your bones.

Understanding risks

The following are additional risk factors for osteoporosis:

Age

Up to around age 30, 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 has been shown to increase your risk for osteoporosis. It also seems to cause earlier onset of menopause, meaning there is less time that your bones are protected by estrogen. Smokers also have a harder time healing after a fracture compared to nonsmokers.

Body composition

Women who are petite or thin have a greater risk of developing osteoporosis compared to women who are heavier or have a larger frame. This is because thinner women have less bone mass overall compared to larger women. The same is true for men.

Existing bone density

When you reach menopause, the greater your bone density, the lower your chance 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.” That’s why you should encourage your children to actively build bone density in their younger years.

Family history

If your parents or grandparents had osteoporosis or suffered a fractured hip as a result of a minor fall, you may be at a greater risk for developing osteoporosis.

Gender

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. Women over the age of 50 have the greatest risk for developing the bone disease.

Race and ethnicity

Worldwide, northern Europeans and Caucasians have the greatest risk of fracture due to osteoporosis. Osteoporosis is also decreasing in this population.

However, the Women’s Health Initiative 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.

Treatment options

A variety of treatments can help stop the development of osteoporosis. Here are some steps you can take to prevent bone deterioration:

Take calcium and vitamin D supplements

Calcium can help build strong bones and keep them strong as you age. The National Institutes of Health recommends that people ages 19 to 50 get 1,000 milligrams (mg) of calcium each day. Women over 50 and all adults over 70 should get 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 like salmon or mackerel are good sources of vitamin D from food, along with foods like milk and cereals in which vitamin D is added.

Sun exposure is the natural way the body makes vitamin D. But the time it takes in the sun to produce vitamin D varies depending on time of day, the environment, where you live, and the natural pigment of your skin.

For people concerned with skin cancer or for those who wish to get their vitamin D in other ways, supplements are available. People over age 50 should get at least 600 international units (IU) of vitamin D every day. People over 70 should increase their daily vitamin D to 800 IU.

Ask your doctor about prescription medications and injectable bone-building agents

A group of drugs called bisphosphonates helps prevent bone loss. Over time, these medicines have been shown to slow bone loss, increase bone density, and reduce the risk of bone fractures. A recent review showed bisphosphonates can reduce the rate of fractures due to osteoporosis up to 60 percent.

Selective estrogen receptor modulators, or SERMs, are a group of drugs that have estrogen-like properties. They’re sometimes used for the prevention and treatment of osteoporosis. A 2011 study showed that the most benefit in SERMS is often in reducing the risk of fractures in the spine up to 42 percent.

Make weight-bearing exercise part of your fitness routine

Exercise often does as much for building and maintaining strong bones as medication does. Exercise makes bones stronger, helps prevent bone loss, and also speeds up recovery in the event of a bone fracture.

Walking, jogging, dancing, and aerobics are all good forms of weight-bearing exercise. A recent study indicates that swimming and water-based exercises also provide some benefit to bone strength, but just not as much compared to weight-bearing activities.

Talk to your doctor about hormone replacement therapy

Hormone replacement therapy (HRT) can help prevent bone loss caused by the decreased levels of estrogen that occurs during perimenopause and menopause. However, experts currently recommend that HRT be used only after other options for bone health have been considered.

HRT may have a role when treating other symptoms of menopause, including hot flashes, night sweats, and mood swings. 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:

  • heart attack
  • stroke
  • blood clots
  • breast cancer

There are also other medical conditions where HRT isn’t the best choice. Talk to your doctor for more information about this treatment option.

The takeaway

Women going through menopause have a higher risk of developing osteoporosis, but there are many ways to slow it down and fortify your body against it.

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