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How Does Menopause Affect Bone Density

You Can Reduce Extra Risk Factors For Bone Loss In Menopause

Bone Density Tests (why have a DEXA scan?) Menopause Shocker

You can do a lot to preserve your bone density and even increase it in the years leading up to menopause and following it just by taking control of your risk factors. Since you dont know exactly when your last period will take place, its best to get started now.

Your nutrient needs change in menopause. When estrogen levels decline, vitamin K function in bones also declines, including its role in the proper formation of bone protein which provides the framework for our bones. Most of us dont get enough vitamin K, especially the most bone-supporting form, vitamin K2 as MK-7. Vitamin K2 MK-7 is found in aged cheeses and fermented foods, including the Japanese dish natto . Dark leafy vegetables such as kale, collards or spinach contain vitamin K1. For many, its so hard to get enough vitamin K through diet that supplementation is required.

Unfortunately, most of us are also chronically deficient in vitamin D, which your body needs to absorb calcium and limits bone breakdown. I recommend every woman have her vitamin D level tested at least yearly its not very costly. Sun exposure boosts vitamin D production in the skin, but you may need supplements to reach the optimal blood levels of 5060 ng/mL. The vitamin best D3 form is cholecalciferol.

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What Causes Postmenopausal And Senile Osteoporosis

Bones are made of complex, constantly changing, living tissue. They are able to grow and heal, and are also susceptible to changes in diet, body chemistry, and exercise levels. These are the changes that can lead to osteoporosis.

Early in life, more bone is laid down than is removed by the body. People typically achieve peak bone mass by around age 30, after which more bone is lost than is replaced. Too much bone loss leads to osteoporosis.

Both of the two primary types of osteoporosis are far more common in women than men:

  • Type I osteoporosis generally develops after menopause, when estrogen levels drop precipitously. These changes lead to bone loss, usually in the trabecular bone inside the hard cortical bone.
  • Type II osteoporosis typically happens after age 70 and involves a thinning of both the trabecular and cortical bone.

Menopause And Your Bones

Menopause is an important moment in a womans bone health. This is because the oestrogen hormone that’s important for keeping bone density stable and maintaining bone strength, decreases. As a result, bone density starts to go down too. With this loss of bone density comes reduced bone strength and a greater risk of breaking bones.

Changes can happen more rapidly in the decade after your menstrual periods stop and then there will be a steady reduction through into old age. This gradual bone density loss affects men too.

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How Common Is Osteoporosis And How Is It Related To The Menopause

An estimated three million people in the UK are thought to have osteoporosis, a condition that weakens the bones and makes them more likely to break.1

More than 500,000 people receive hospital treatment for fragility fractures every year because of osteoporosis, according to NHS.uk.2

Yet alarmingly, osteoporosis is often referred to as a silent disease as so few people are aware that they have the condition until they suffer a fracture.

The risk factors for osteoporosis are numerous, but gender and age are two key risks. An estimated one in three women over 50 worldwide will develop osteoporosis, compared to one in five men.3

And this is where the menopause comes into play.

The menopause is when the ovaries stop producing eggs and as a result, levels of hormones, oestrogen, and progesterone fall. As well as being a key reproductive hormone, oestrogen helps to protect the bones and maintain bone density. So, when oestrogen levels decline during the menopause, this has a direct impact on bone health.

Our bones are a living tissue, with cells in the body constantly laying down new bone and other cells removing old bone . Until the age of 30, our bodies normally build more bone than is lost.

However, during the menopause, bone breakdown occurs at a faster rate than bone build up, resulting in a loss of bone mass. The stark fact is that around 10% of a womans bone mass is lost in the first five years of the menopause alone.

Exercise 30 Minutes A Day

Osteoporosis

Incorporate a combination of high impact exercise and muscle strengthening exercise into your weekly routine. High impact exercises include jogging, stair climbing, tennis and aerobics anything that gets your feet stomping. Your bones respond to this by creating stronger, denser cells. If you find high impact activities are hard on your joints, low impact activities like the elliptical machine and walking are other good choices. Muscle strengthening exercises include lifting weights, exercises using resistance bands or your own body weight, yoga and Tai Chi.

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Breast Cancer Treatments And Bone Loss

Many breast cancer treatments increase the risk of bone loss by lowering estrogen levels in the body. If youre premenopausal when youre diagnosed with breast cancer, the following treatments can accelerate bone loss:

  • certain types of chemotherapy that cause either temporary or permanent menopause
  • medications known as luteinizing hormone-releasing hormone agonists, which shut down the ovaries production of estrogen temporarily or permanently in some cases
  • surgical removal of the ovaries, which is recommended for some women
  • the hormonal therapy tamoxifen, which blocks the effects of estrogen in cells throughout the body and, as a result, can interfere with bone density in premenopausal women
  • aromatase inhibitors . If youre diagnosed with hormone-receptor-positive breast cancer after menopause, you might be prescribed aromatase inhibitors that can cause bone loss. These include Arimidex , Aromasin , and Femara . AIs stop the production of estrogen in your body. The main sources of estrogen in postmenopausal women are the adrenal glands and fat tissue, not the ovaries. If youre postmenopausal and take tamoxifen, on the other hand, it actually can help build bone density. For postmenopausal women, tamoxifens effects on bone is similar to the effects of the estrogen you used to have in your body naturally.

Take Care With Weight Loss

Many women are surprised to hear that losing weight can be a significant risk factor for bone loss in perimenopausal and recently menopausal women. Its not that weight loss is itself necessarily unhealthy if youre overweight or obese, its still a good idea to address the health issues that have led to your excess weight. But the methods you use to lose weight are very important, and I would caution all women who plan to lose weight during the years leading up to and right after the menopausal transition to take rigorous steps to protect their bones.

Researchers all around the world have noticed that the combination of low weight and advancing age are the most important risk factors for determining low bone density. In fact, if a practitioner does no other tests or screening at all, she can predict who is likely to have low bone density simply by looking at age and weight. And when postmenopausal women lose weight, they tend to lose bone. The numbers indicate that a 10% loss in body weight will give you about 1% loss in bone mass.

Personally, my favorite theory is that our prevalent chronic low-grade metabolic acidosis is worsened by calorie restriction, high animal protein and/or high fat diets leading to a loss in the urine of calcium and other bone nutrients. Ultimately, how you lose weight is a key factor in whether your weight loss improves your health .

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Prevention And Treatment Strategies

When it comes to bone loss, prevention truly is your best defense. Whether testing shows any evidence of bone loss or not, the following strategies can help keep your bones strong:

  • calcium at 1,200 mg/day, taken through a combination of diet and supplements. Good sources of calcium include:
  • low-fat dairy products such as milk, cheese, and yogurt
  • goods such as leafy green vegetables, almonds, and beans
  • calcium-fortified foods such as fruit juices and cereals
  • vitamin D at 800-1,000 IU/day or more. Multivitamins typically include 400 IU, so you may need an additional supplement.
  • quitting smoking
  • weight-bearing exercises that help strengthen bones
  • maintaining a healthy body weight
  • limiting alcohol use
  • If bone density testing shows that you have worsening osteopenia or osteoporosis, your doctor may recommend you take a bisphosphonate. Bisphosphonates interfere with the activity of bone cells known as osteoclasts, which reabsorb bone tissue . This helps to reduce bone turnover and boost bone density. Common examples include Fosamax Actonel Boniva and Zometa and Reclast .

    Besides bisphosphonates, other medications that may be used to treat osteoporosis in women whove had breast cancer include:

    • Evista : Evista is a selective estrogen response modifier that can be used to treat osteoporosis in post-menopausal women.
    • Prolia : Prolia helps stop the development of cells that are responsible for removing old bone. As a result, the rate of bone loss slows.

    Tools To Help Evaluate Your Risk For Bone Fracture And Osteoporosis

    How to Maintain Bone Density Through Menopause and Beyond

    The American Bone Health Fracture Risk Calculator can be used to assess risk for postmenopausal women. By inputting your answers to questions regarding your age, lifestyle habits, medical and fracture history, the calculator aims to tell you your risk for bone fracture in the next ten years. Give it a shot here.

    A more hands-on way to understand your osteoporosis risk is to have your bone mineral density measured. These are simple X-rays taken to examine the density and strength of your bones. If you have osteoporosis, this can also tell you how severe it is.

    Its recommended that the following postmenopausal women have a BMD test done:

    • Those who experience a fragility fracture. A fragility fracture is a fracture you can get after exposure to a low trauma, or sustaining a fracture that normal people would not have. Low traumas are those occurring from a fall from a standing height or less, without major trauma like being in a car accident.

    • Those under the age of 65 who have at least one risk factor for osteoporosis.

    • Those over the age of 65, regardless of additional risk factors.

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    Screening For Premenopausal Osteoporosis

    Women that are not of menopausal age usually do not get bone density testing unless a fracture happens that could indicate a problem. If low bone density for your age is found, then your doctor can discuss your treatment options.

    If you have a higher risk for premenopausal osteoporosis, bone density testing may help you and your doctor detect bone loss early. Then you can take steps to help preserve the bone you have. Ask your doctor if you should be screened if any of these apply to you:

    • Youâve taken steroid drugs such as prednisone for a long time
    • You have one of the diseases linked with bone loss, including thyroid disease or rheumatoid arthritis
    • You’ve had early menopause

    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 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 cant 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 cant 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.

    According to the , people ages 19 to 70 should get at least 600 international units of vitamin D every day. People over 70 should increase their daily vitamin D to 800 IU.

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    Ask Your Doctor About Prescription Medications And Injectable Bone

    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 2017 study showed bisphosphonates can reduce the rate of fractures due to osteoporosis up to 60 percent.

    Monoclonal antibodies can also be used to help prevent bone loss. These drugs include denosumab and romosozumab .

    Selective estrogen receptor modulators, or SERMs, are a group of drugs that have estrogen-like properties. Theyre sometimes used for the prevention and treatment of osteoporosis.

    A showed that the most benefit in SERMS is often in reducing the risk of fractures in the spine up to 42 percent.

    Inclusion And Exclusion Criteria

    Pin on Health

    Studies were included if they met the following criteria: randomized or non-randomized controlled trials with at least one exercise group as an intervention vs. one control group with habitual lifestyle or sham exercises participants were post-menopausal at study onset the training program lasted a minimum of 6 months BMD of the LS or/and the proximal femur regions total hip and/or FN were used as outcome measures baseline and final BMD assessment reported at least for one desired regions BMD measurement assessed by dual-energy X-ray absorptiometry or dual-photon absorptiometry studies with 10% of participants on hormone replacement therapy , hormone therapy , adjuvant endocrine therapy, antiresorptive, or osteoanabolic pharmaceutic agents or drugs with a dedicated osteo-catabolic effect on bone metabolism, , albeit only if the number of users was similar between exercise and control.

    Studies addressing interventions applying novel exercise technologies mixed gender or mixed pre- and post-menopausal cohorts without separate BMD analysis for PMW PMW under chemo- and/or radiotherapy PMW with diseases that affect bone metabolism the synergistic/additive effect of exercise and pharmaceutic therapy, or duplicate studies or preliminary data from the subsequently published study and review articles, case reports, editorials, conference abstracts, and letters were excluded from the analysis.

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    What Can I Do About These Changes

    Some of these changes are inevitable with the physiological hormonal changes. However, lifestyle factors have been shown to be some of the most significant factors contributing to the loss of bone and muscle mass, including a lack of physical activity, inadequate protein intake and inadequate calcium and vitamin D intake. These are therefore essential targets.

    So what can you do to prevent, treat or reverse the effects of sarcopenia and osteoporosis?

    The prescription includes:

    • Start regular strength based exercises.

    Resistance strength based exercise has been shown to be one of the best interventions to treat, slow down, reverse and prevent the effects of both sarcopenia and osteoporosis. To learn more about this, check out our introduction to strength training for older adults, or try out one of our fitness plans, suited to your level of ability.

    • Ensure you are consuming enough protein in your diet

    Protein guidelines vary depending on activity levels. A general guide for a moderately active adult is 0.8g of protein per kg of body weight every day . However, ageing muscles do not respond as well to protein as younger muscles. They have a reduced ability to use the available protein, and therefore as you get older, there is actually a greater demand for protein.

    • Ensure you are meeting the calcium and vitamin D requirements

    The NHS recommends everyone in the UK takes a vitamin D supplement throughout autumn and winter, and at risk individuals all year round .

    Bone Strengthening Medications After The Menopause

    HRT is usually considered the most appropriate osteoporosis treatment if you are under 50 and have passed the menopause. It is effective at reducing the risk of a broken bone by giving you the same exposure to hormones as the average women.

    There have been concerns that giving HRT beyond this time might increase the chance of some health risks like breast cancer, blood clots or stroke. Research studies have previously suggested that taking HRT long term increased these risks. This was especially in older women who had a higher background risk of these conditions to start with. In recent years however, the evidence from some trials has been more reassuring.

    The current thinking is that HRT is generally safe and effective for menopausal symptoms. If used on a short-term basis, the benefits for most women will outweigh any risks. Most experts would also consider HRT as a useful option for osteoporosis treatment in women between 50 and 60, after a discussion of individual risks and benefits. HRT might be especially useful for women who also have menopausal symptoms. You will usually be offered other bone strengthening medications after the age of 60 years.

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    How To Prevent Osteoporosis In Menopause

    As you approach perimenopause and menopause, your nutrient needs change. Along with decreased levels of estrogen, levels of vitamin K and vitamin D in your body also decrease during this time. With the onset of menopause, you should also consider increasing your intake of calcium-rich foods. Dr. Dweck recommends getting at least 1200mg of calcium, mostly through dietary intake, and 800 international units of vitamin D every day. Good sources of calcium include fortified dairy products, salmon, almonds and dark leafy greens like kale, collards, and spinach. If you feel that you still arent getting enough calcium, vitamin D, and vitamin K in your diet, consider taking a supplement.

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