Why it’s vital we think about our bone health early
Osteoporosis is a silent disease; we often don’t even know we are affected by osteoporosis until we suffer a bone fracture. Such fractures, usually painful and most commonly of the spine, wrists and hip can severely affect our later quality of life and functional mobility. Of those who experience hip fractures, half may not return to their previous lifestyle and 20% die because of their fracture.
Osteoporosis simply means porous bones, weaker as a result and more likely to fracture. Osteoporosis is usually diagnosed when bones have lost a significant amount of bone density and strength, making them more prone to breakage. Until we are 30 years of age, we are constantly building new bone compared to bone degradation. As we age, bone loss exceeds bone formation, and we lose bone strength and bone density.
Half of women over 50 years of age develop osteoporosis, and most will suffer a fracture during their lifetime.
Other risk factors for osteoporosis
Long-term oral corticosteroid treatment
Calcium deficiency
Vitamin D deficiency
Increasing age
Early menopause or premature ovarian insufficiency (POI)
Low body weight
Low levels of physical activity
Smoking
Moderate to high alcohol intake
Other medication including aromatase inhibitors, phenytoin, carbamazepine, heparin & medroxyprogesterone (Depo-Provera)
Oestrogens and testosterone’s role in bone metabolism
Our bones are made of living growing tissue, that is constantly turning over, breaking down old and growing new bone. The task of breaking down old bone falls to ‘Osteoclasts’ while the regeneration is handled by ‘Osteoblasts’ with oestrogen controlling the balance. When oestrogen levels decline, more bone is broken down and the turnover of new and old bone is unbalanced, resulting in more bone resorption (bone becoming mineralised and reducing in density).
It’s not all about Oestrogen. Testosterone is produced alongside in the ovaries and is important for muscle strength and mass which is also a factor in bone remodelling during strength exercise.
It’s never too late to be treated for osteoporosis
There are several treatment options available to help osteoporosis and there are many lifestyle adjustments that we can make to improve our bone density.
Lifestyle adjustments to support bone health
1. Ensure adequate dietary calcium intake of 1000mg daily.
2. Use a calcium calculator to assess your current daily intake
3. Take a daily vitamin-D supplement all year round. 10 micrograms daily (400 IU)
4. Resistance, balance, and weight-bearing exercises 3 x per week
5. Reduce risk factors mentioned above
Hormone replacement therapy (HRT)
Hormone replacement therapy helps to prevent and treat osteoporosis by replenishing the declining oestrogen levels. There is no upper age limit for HRT treatment, however using HRT above 60 years of age should be considered on an individual basis according to benefits and risk factors. There are alternative treatments If HRT is not appropriate.
HRT during the perimenopause helps to prevent bone degradation at an early stage and HRT after the menopause treats any reduction in bone density that has already happened and prevents further loss.
Weight-bearing and resistance exercise
Weight bearing exercise helps to increase strength and bone density through rejuvenation and includes any class of exercise where we are standing with the weight of our whole body pulling down on our skeleton. This can include walking, jogging, tennis, jumping, dancing etc.
Muscle strengthening exercises increases muscle mass and bone density too. Try to do weight-bearing / muscle strengthening exercise at least three times per week.
Thinking about bone health in the perimenopause
The perimenopause is an important time for women to review their lifestyle and overall health. The perimenopause provides us with the opportunity to make changes earlier in life when it’s easier to improve weight management, exercise, and diet. Making sustainable habits in the perimenopause reduces our health risks later in life.
What can we do to improve our bone health now and in the future?
1. Daily Vitamin-D supplement 10mcg (400IU) all year
2. Ensure adequate calcium intake, 1000mg daily
3. Weight-bearing/resistance exercise 3X weekly (build up slowly to 30 minutes)
4. Reduce risk factors
5. Consider HRT during the perimenopause and beyond
6. Be aware of increased risks due to chemotherapy, early menopause, and other medication
Dietary sources of calcium
Calcium is abundant in many foods, dairy being the richest. Ensure you choose unsweetened, full-fat and organic varieties as much as possible. Non-dairy sources of calcium include green leafy vegetables such as kale, okra and broccoli. Other great plant-based sources of calcium are tofu, sesame seeds, pulses, dried apricots and wholegrain bread.
Lifestyle medical review
Speak to one of our menopause specialists to discuss your lifestyle and medical needs to help you make improvements to your future health. Our menopause consultations focus on both perspectives to give you a holistic approach to care.
Further resources
1. The Royal Osteoporosis Society
2. NICE guidelines: Osteoporosis
Kate Organ, Consultant clinical pharmacist with specialist interests in the menopause and mental health. Founder The Menopause Specialists
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