Osteoporosis is a bone disease that weakens bone mass and density, putting you at higher risk of fractures. Hormonal changes after menopause can impact bone health, as estrogen levels naturally drop. This can lead to postmenopausal osteoporosis.
When discussing this type of osteoporosis, it’s important to understand the connection between menopause and bone health. We’ll overview the changes during menopause that contribute to osteoporosis, how it’s treated, and what risk factors to look out for.
In this article, we use “male” and “female” to refer to someone’s sex as determined by their chromosomes, and “men” and “women” when referring to their gender (unless quoting from sources using nonspecific language).
Sex is determined by chromosomes, and gender is a social construct that can vary between time periods and cultures. Both of these aspects are acknowledged to exist on a spectrum both historically and by modern scientific consensus.
People of any gender may go through menopause.
An estimated 50% of postmenopausal people will experience osteoporosis, and menopause is the most common cause of osteoporosis.
Menopause involves more than simply not having a period anymore. The ending of the menstrual cycle indicates a person’s estrogen levels are decreasing. This is because their ovaries no longer produce estrogen to stimulate the menstrual cycle.
While we tend to think of our bones as solid, your body is actually constantly breaking down and rebuilding bone. Estrogen is a hormone that plays an important role in maintaining bone strength. Specifically, estrogen slows bones from breaking down.
Not only does the lack of estrogen increase your osteoporosis risk, but so does the amount of time since you’ve undergone menopause. In a study regarding osteoporosis risks, women who were 20 years past menopause were at significantly increased risk for osteoporosis. The longer that you’re exposed to lower estrogen levels, the more your osteoporosis risk goes up.
While it seems like a small descriptive difference, it’s important to remember that people undergo menopause at different ages. It’s the time since a person underwent menopause and not their total age that can affect their risk.
Other risk factors
While menopause is a strong risk factor for osteoporosis, others exist as well. Additional osteoporosis risk factors include:
- poor nutritional intake: Eating a diet high in processed food and lacking a variety of vitamins and minerals can
increase the riskfor osteoporosis.
- heavy alcohol consumption: Drinking significant amounts of alcohol on a regular basis is associated with
greater risksfor hip fracture and reductions in bone density.
- cigarette smoking: Smoking may affect the release of hormones that cause bones to break down more quickly. These hormones include parathyroid hormone and the hormone that maintains vitamin D levels in the body.
- family history: If you have a family history of osteoporosis, you may be at greater risk for osteoporosis compared to someone who doesn’t.
- taking certain medicines: Glucocorticoids, such as prednisone and dexamethasone, are immune system-suppressing medications. Those with a history of organ transplant, autoimmune, and many other disorders take them to manage their medical condition. Unfortunately, these medicines can negatively affect bone and cause bone loss.
- having certain medical conditions: Doctors
associate some medical conditionswith a greater risk for osteoporosis such as:
While many of these factors you can’t change, it’s important to know how they affect your osteoporosis risks. If any of these risk factors apply to you, discuss them with your doctor as you go through menopause.
Osteoporosis is often considered a “silent” disease because it often doesn’t cause symptoms until the condition has advanced. However, a person with osteoporosis is at
- affected function
- back pain
- decreased mobility
- experiencing fractures (bone breaks) in your back, wrists, or hips
- experiencing changes in posture, such as kyphosis, or taking on a hunchback appearance
- losing a noticeable amount of height, sometimes up to 2 inches
Many people don’t know they have osteoporosis until they experience a bone fracture. That’s why doctors recommend regular screenings after menopause to help them identify who may be at risk. Talk with your doctor about the best screening regimen for you.
Doctors diagnose osteoporosis by estimating bone mineral density. Your bones’ density is one of the things that make them strong and resilient to breaking.
Doctors will measure bone density using a special imaging machine called a dual-energy X-ray absorptiometry (DXA or DEXA) machine. They’ll then assign you either a T- or Z-score based on their measurements.
- A T-score assesses your bone density in comparison to those who are younger than you.
- Your Z-score compares your bone density to those in your age group.
Doctors will usually measure your bone density at your hip, but they may also look at your ankle or wrist. They may also use imaging studies of the spine, such as computed tomography (CT) scan or magnetic resonance imaging (MRI) to measure how or if osteoporosis has affected your spine.
If you are taking medications or using lifestyle changes to reduce your osteoporosis risks postmenopause, your doctor will recommend a duration for regular monitoring. For high-risk people, this will usually involve getting a DEXA scan every 1 to 3 years to determine how well you’re responding to treatment. Most people may only need to get screened every 5 years.
If you experience postmenopausal bone loss, there are a variety of treatment options. Many are medications that help to promote bone growth and stability, helping to keep bone from breaking down. Your doctor will take into account your overall health, osteoporosis risk, and potential side effects when determining what medication to prescribe.
Medications a doctor may prescribe to treat osteoporosis include the following.
Bisphosphonates help reduce postmenopausal osteoporosis by reducing the rate of bone loss. These are often first-line treatments for those at high risk for osteoporosis fractures. Examples of these medications include alendronate, zoledronic acid, risedronate, and ibandronate.
Denosumab, also called Polia, is a medication given via intravenous (IV) line or injection. The medication helps to reduce your risks for bone breakage by keeping your bones from breaking down too fast. If you can’t take bisphosphonates, denosumab is an alternative treatment.
This medication is given via self-injection daily and is prescribed to those that are at very high risk for osteoporosis fractures. The medication helped to reduce spine fractures and other bone fractures, but you can’t usually take it for more than 2 years.
This injectable medication is a “sclerostin blocker” that doctors usually prescribe to those who are at very high risk for postmenopausal fractures.
Estrogen therapy is a hormone replacement treatment that helps increase the body’s estrogen supply because the ovaries no longer produce as much estrogen.
Calcitonin is a hormone naturally found in the body that can help control calcium levels and also prevent bone loss. If you are at least 5 years postmenopausal, you may be able to take calcitonin via a nasal spray.
Taking calcium and vitamin D supplements may help to strengthen bone by encouraging the formation of new bone. This can help to keep new fractures from happening.
In addition to medications, there are lifestyle changes you can make that will likely enhance your bone health. These include:
- Eating a diet that contains sufficient amounts of calcium and vitamin D. Calcium-containing foods include dairy products, almonds, edamame, tofu, and fortified foods, such as orange juice and cereal. Vitamin D is also found in fortified foods, salmon, tuna, sardines, and egg yolks.
- Engaging in regular weight-bearing exercise (exercises like swimming aren’t as effective in bone-building). Resistance training, such as lifting weights and using resistance bands, can help build stronger bones.
- Maintaining a healthy weight helps to keep bones strong and reduce the demands placed on them. Being underweight can be especially harmful in osteoporosis risks.
- Avoiding habits that can break bones down too early, such as smoking or drinking excessive amounts of alcohol.
You can also talk with your doctor about how to reduce your osteoporosis risks after menopause.
Living with osteoporosis in postmenopause
Going through menopause can be overwhelming, especially if it causes osteoporosis or other health problems. Talk with your doctor to see if they have recommendations for therapists that specialize in menopause. The following resources can also help:
Menopause causes hormonal decreases in estrogen that can increase your risks for osteoporosis. Medications and lifestyle changes can help you reduce osteoporosis risks and enhance your overall health.
If you are nearing menopause or have gone through menopause, talk with your doctor about your risks and how to reduce them.