The Correlation Between Menopause and Osteoporosis

Osteoporosis is a condition that causes bones to become weak and break more easily.

It can affect anyone, but the risk goes up with age, and is significantly higher among women. According to the National Institute on Aging, one in five women over the age of 50 have osteoporosis, compared to only one in every 20 men. Menopause may be putting women at risk, as osteoporosis is often present during or shortly after menopause.

How Menopause Increases Osteoporosis Risk

The increased risk for osteoporosis during menopause is two-fold.

We have two types of bone management cells in our body: osteoblasts and osteoclasts. Osteoblasts build new bone, and osteoclasts take away old bone. In younger years, osteoblasts outnumber osteoclasts as new bone is being created at a rapid rate as you grow.

In early adulthood, the two bone management cells reach an equilibrium, properly building and taking away bone. As we age, osteoblasts begin to decline and osteoclasts start winning, causing a loss in bone mass.

“This decrease in bone mass is amplified during menopause as estrogen in the woman’s body begins to decrease, and therefore no longer keeps osteoclasts in check,” shares Justin Lea, MD, an orthopaedic surgeon with ProMedica Physicians.

When this decrease is significant enough, it can cause weak, brittle bones – and, eventually, lead to osteoporosis.

How Osteoporosis is Diagnosed

Osteoporosis is oftentimes a silent disease, and women don’t receive a diagnosis until after a bone injury occurs.

“We often see women who experienced a bone break or fracture from an injury that we wouldn’t expect to normally cause one,” Dr. Lea shares. “This signals us to run additional tests that may lead to a diagnosis.”

However, if you’re concerned about your osteoporosis risk, your primary care provider can help. Identifying osteoporosis or osteopenia (a precursor to osteoporosis) early can help you manage the condition and preserve the bone mass that you have left.

If you have risk factors for osteoporosis, or are experiencing symptoms, your primary care provider may recommend a diagnostic test called a DEXA scan. DEXA scans use low-energy radiation to access bone mineral density. Results of the test include two scores: a T-score and a Z-score.

The T-score compares your bone density to that of a healthy 25-year-old. The Z-score compares your bone density to that of someone your own age.

Typically, the T-score is what is used to diagnose osteoporosis. A T-score greater than -2.5 indicates osteoporosis and a score between -1 and -2.5 indicates osteopenia.

How To Decrease Your Risk or Slow the Progression

Whether you’re a young woman, are approaching menopause, or are beyond that phase of life, there are actions you can take to reduce your risk of developing osteoporosis or slow the progression of the disease.

Increase Impact Exercise

“Wolf’s law states that bone adapts to the nature of loading it’s chronically exposed,” Dr. Lea shares. “Basically, this means that the more load bone sustains, the stronger it gets.”

You can strengthen your bones by regularly exercising and incorporating more impact exercises into your routine. Impact exercise includes anything that puts additional load on your body such as weight training or running. “If you have osteoporosis, it’s valuable to establish an exercise routine in collaboration with a physical therapist,” Dr. Lea shares.

Prioritize Nutrition

Ensuring you have adequate calcium, vitamin D and protein in your diet can also decrease your risk for osteoporosis.

Your primary care provider can perform a blood test to determine your calcium and vitamin D levels. “If you’re deficient, supplement with 1000mg of calcium and 600-800 IU of vitamin D,” shares Nicholas Schenk, MD, a family medicine provider with ProMedica Physicians.

Increasing these nutrients naturally is also important. Eat a healthy diet and increase the number of calcium-rich foods that you eat every day. This may include foods such as cheese, milk, broccoli, beans, nuts and seeds. Spend more time outside to naturally increase your body’s levels of vitamin D.

Additionally, decrease your alcohol intake and if you smoke, stop smoking.

Take Medications

If you’ve been diagnosed with osteoporosis or osteopenia, medications can help. The first medications providers typically turn to are bisphosphonates.

“Bisphosphonates help slow the turnover in bone,” shares Dr. Schenk. “These types of medications build up in the bone, so typically patients take them once a week (or once a month) for a few years and then are able to take a break from them for a while.”

However, some patients experience negative side effects with these types of medication.

Denosumab (brand name Prolia®) is a newer treatment that can provide a targeted response via an injection. “This drug is very effective in managing osteoporosis. The medication is administered every six months and can work well for people who don’t respond well to the other medication options,” Dr. Schnek shares.

For some women, hormonal therapy to help manage estrogen levels can also be effective.

Make Other Lifestyle Modifications

Making modifications to decrease your risk of falls that may cause future fractures is important. “Consider installing a shower bar and removing rugs in your home,” Dr. Schenk shares.

“Doing everything that you can do to prevent a fracture or break before it happens is imperative,” Dr. Lea stresses. “Also, treat any existing fractures or injuries so that they don’t worsen or lead to further decline or problems.”

Dr. Schenk often sees the disease progression stall among patients who make positive lifestyle modifications. These changes allow new bone to be built again, and old bone to be removed at a slower rate.

Work with your physician and start building healthy habits today to keep your bones strong for years to come.