Menopause and Bone Loss: How to Protect Your Skeleton in Your 40s and 50s
Here is what most women in their 40s are not familiar with: by the time you first notice that your bone is broken or the vertebra collapsed, the loss of the bone behind those areas might have been slowly accumulating over 10 or more years.
The loss of bone mass such that the bones break easily due to minimal pressure has been referred to as the silent thief. There are no symptoms while it develops. No pain, no alarm, no specific indication that somebody is transforming something within the skeleton. Most women learn that they possess it, only by breaking a wrist by a small accident or at worst, they break a hip.
It is just the menopause transition; it is the most important period in the life of a woman as far as bone loss is concerned. The knowledge of why and what to do about it could make a significant difference to how the skeleton would continue to support not only in the 50s but decades to come as well.
Bone is not a rigid structure. It is in fact a living tissue that is in a continuous state of breaking down and rebuilding. And picturize it as a city under a certain degree of continuous construction a building gets torn and another is erected. In the normal skeleton the rate of regeneration is equal to the rate of disintegration.
One of the primary regulators of this process is Oestrogen. It pulls down the degrading side of the cycle, such that the demolition crews do not work too quickly. With a high amount of oestrogen, bone turnover is at the optimum and bone density is maintained. Oestrogen loss leads to accelerated breakdown of bone and insufficient rebuilding on the other side with the resultant consequence being a skeleton that loses more bone than it can counter.
Bone loss is not a constant rate of change. It is quickest in the years directly following the last period. On average, women lose up to 10 per cent of their total bone mass in the first five years after menopause. It is not a gradual, gradual wearing away. It is swift increase, which occurred right at the period when the vast majority of women do not ponder about their bones at all.
Bone loss persists, although at a slower rate, after the initial five or so years. That is why the best results are achieved by doing the acting in 40s and the early 50s before or in the period of transition. The subsequent protective processes are laid down the more bone density one has to defend.
The two terms are used more often and may be misleading. They can be most easily conceived on a continuum. Osteopenia merely reflects the bone density that is lower than ideal. It is an initial alert signal. The bones are not as thick as they should be, but are not yet so delicate that they can easily break. The more severe Osteoporosis whereby the bones have lost too much mass such that, it only takes a relatively small amount of force to fracture it such as a slight bump, a fall that raises ones stature, a forceful sneeze or a stiff connection in the awkward direction would cause it to break.
One-half of women 60 and above have less than normal bone density, and one in four has osteoporosis. Such conditions are not uncommon. They are extremely likely consequences of a menopause transition that was not actively dealt with with a view to bone health.
Fracture of wrist due to a fall is painful and inconveniencing. However, the aftermath of osteoporosis is much more than that.
It is in case of the hip fractures that the end result becomes severe. In older adults who have sustained a hip fracture, studies indicate that about every third of them will regain their previous level of mobility and independence. A third of them become severely disabled in the long term. And one in three succumbs in the next year.
Spinal fractures are those that tend to occur without any tangible outer pressure, lead to a shrunken height with time, progressive development of a stooped and curved position, and the possible cause of chronic pain. Most women who become short or bent in their 70s and 80s had never noticed that the vertebrae in their spine were gradually collapsing due to the loss of bone that they had been losing for years and had not done anything about.
These are not foregone conclusions. These can be mostly avoided especially when acted upon during the 40s and 50s when the bone density can still be significantly saved.
Not all of the factors that increase the risk of considerable bone loss can be altered but being aware of them allows prioritising action:
Low Calcium Intake: bones are composed of calcium. Lifetime inadequate calcium dietary intake translates to entering menopause with a reduced peak bone density and reduced resistance to future bone losses.
Exercise is not created equal, as far as bone health is concerned. The skeleton is load responsive. With physical activities, putting bones under strain, the bones in response become denser. Activities that achieve this best are grouped into three and hopefully a weekly schedule can be made to have an element of each of the three.
The former is impact loading. Activities which involve getting on your feet with relative force (i.e. walking fast, jogging, dancing, climbing stairs, playing tennis, netball or jumping) count. The frequent influence conveys a message to the bone cells that the structure should be strong. The activities that do not give this to the bone include gentle, non-impact activities such as swimming, cycling, which are good in cardiovascular health.
The second one is strength training otherwise known as resistance training. The exercises pushing and pulling the muscles with weights, resistance bands, or body weight strains the bones to which the muscles are attached, prompting them to retain their density. The evidence-based recommendation is two-three sessions a week focusing on all major muscle groups. This also develops muscle strength that prevents falls in the inception.
The third one is a balance training. Most osteoporotic fractures are as a direct cause of falls. Balance and coordination exercises: standing on one leg, Tai chi, yoga, side stepping, decrease the risk of falling. The evidence suggests about two hours per week of movement balance based.
The Australian women of postmenopausal age require 1,300 mg of calcium daily. This is quite a lot compared to the early stages in life, and majority of the women are failing to receive it.
It is aimed at achieving this target by means of food rather than through supplements. Most of the requirement is met by three or four servings of dairy, including milk, yoghurt and cheese. The machine will have several non-dairy options: calcium-enriched plant milks, bone-tinned sardines and salmon, firm tofu, almonds, and dark, leafy greens such as kale and bok choy.
In case diet does not meet the target, diet may be supplemented with 500-600 mg/day. The supplement blog of this series discusses why the extreme high dosage of calcium supplements have their own genesis and why the food-first recommendation is heavily endorsed.
A pair are calcium and vitamin D. When a person is not getting sufficient vitamin D, they are not able to absorb calcium effectively in the gut however much the person is taking calcium. Deficiency of vitamin D appears incongruent with sunny Australia since the vitamin can be synthesized by the human body in the skin when it is exposed to the sun. Nonetheless, it is more prevalent than anticipated especially in south states in winter and women who cover their skin or spend largest periods of time indoors.
Vitamin D levels are sensed in a basic blood test. When quantities are low, a vitamin D supplement is simple, cheap and highly effective. Healthy Bones Australia suggests 50 nmol/L which is the minimum regular level especially at the end of winter when the levels are at such a low level.
Also known as a DXA scan (dual-energy X-ray absorptiometry), bone density scan is a painless, quick low-dose X-ray used to measure bone density levels at the hip and spine. It lasts approximately ten minutes and entails lying motionlessly on a table. It is considered the gold standard of diagnosing osteoporosis and monitoring the maintenance of bone density in the long term.
All postmenopausal women older than age 65 are typically advised to undergo bone density testing as per Australian guidelines. In women that are younger than 65, an earlier scan is advised in case there are risk considerations. Such risk factors are early menopause, family history of osteoporosis or hip fracture, history of fracture after minor fall in adulthood, chronic corticosteroid use, low body weight or smoking.
The sooner a low bone density level is detected the more time to take action about it. The early 50s detection of osteopenia provides a huge opening of opportunity in terms of lifestyle and, in extreme cases, medical treatment. Delaying till the fracture happens eliminates that chance.
There are two lifestyle factors that contribute greatly to bone loss, and thus need particular consideration:
Lifestyle measures are usually no longer effective for the women with confirmed osteoporosis or extremely low bone density. There are a number of efficient medical therapies, and they should not be fearful about them.
The hormone therapy (MHT) prevents bone loss and at menopause it has the ability to maintain bone density on an average of five per cent in two years of use. Research indicates that it equally prevents hip and spine fractures by approximately 40 per cent. Most correctly and suitably it is advised to women who are below the age of 60 years and are experiencing menopause symptoms and have bone health issues. In cases of the need to protect bone, its maintenance is necessary via constant MHT because the bone degenerates when discontinued.
The drugs are known as bisphosphonates and they act by slowing bone decay. They are very efficient in preventing the occurrence of fractures, they come in the form of weekly or monthly pills or rarely in infusion into a vein and they are well tolerated. They are commonly used as the initial medicine intervention of osteoporosis among non-MHT using postmenopausal women.
Denosumab is a type of injection administered after every 6 months and it helps in lowering the breakdown of bones. It is an alternative to the use of bisphosphonates by women who are unable to use those. Worth mentioning is that in case denosumab is discontinued the bone loss may go back up very quickly and therefore a medical plan on the transition into the alternative treatment must be developed.
They are choices to be discussed with a GP or a professional as he/she can evaluate personal bone density, the risk of fractures, medical history, and others. They are not one-size-fits-all choices.
An example like that that is handy is to put bone health in perspective: consider how high blood pressure is treated. The majority of hypertensive individuals are very comfortable. Produces none of the symptoms. But doctors do annually screening since to treat it in the early stages avoids heart attacks, strokes, and deaths otherwise occurring many years later.
The loss of bone is precisely the same. When it is occurring, its symptoms are nonexistent. The results are years later in the form of fractures, disability and less independence. The reason why it is important to check bone density and protect it now is no more than the reason it is important to control blood pressure not because anything is wrong today but because something preventable is occurring silently.
The most significant bone window a woman would have is her 40s and 50s. The bone mass that is accumulated up to this stage symbolizes the store that the skeleton is going to be depending on over the decades. The fate of that reserve during and after menopause will be vastly influenced by the decisions made today.
The lack of resistance and impact exercise, sufficient calcium intake through food, vitamin D level to maintain in a normal range, lack of smoking, moderate drinking, and the timely bone density check are not complicated measures. They are particular, scientifically validated practices that together safeguard one of the most crucial buildings that the body possesses.
The skeleton is the thing that supports it all. It warrants the notice.