Health advocates across the world strive hard to spread awareness of menopause. Yet, it remains a stigma, surprisingly, not only in low-income families but even in affluent, educated families. The lack of understanding that it is a natural ageing process a woman goes through is not limited to social and cultural taboos but also has implications for the woman’s health. One of the most common conditions associated with menopause is Osteoporosis. Would you be surprised to know that you can prevent post menopausal osteoporosis? Yes, knowing why your bones get weaker after menopause and how to make them strong go a long way in preventing osteoporosis.
What is menopause?
Menopause is when you don’t get your periods (amenorrhea) for 12 consecutive months without any obvious causes or bodily abnormalities.
It is a natural physiological phenomenon due to primary ovarian failure and apoptosis or programmed cell death.
What is osteoporosis?
Your bones go through bone metabolism lifelong, where it gets rid of mature bone and grows new bones. Your bones look like a honeycomb when bone metabolism is normal. With osteoporosis, bone metabolism gets sluggish, and your bones look more porous. The clinical aspects of osteoporosis are reduced bone density and weakened bones, prone to fractures.
Menopause and Osteoporosis
During the menopausal transition, many bothersome symptoms occur, such as hot flashes, vaginal dryness, night sweats, painful intercourse, sleep disturbances, and mood swings.
Besides all these, osteoporosis is the most prevalent condition in menopausal-age women. Osteoporosis mainly occurs in women 10-15 years after menopause.
Why is osteoporosis post menopause a concern?
Post menopausal osteoporosis severely affects the quality of life. Your mobility reduces, and you also lose a sense of balance. Further, you may need assistance with your daily activities and may be prone to hip, spine, and wrist fractures.
Also, with the increasing ageing population, osteoporosis and osteoporosis-related fractures are becoming a significant economic burden on health resources.
How to detect osteoporosis?
Being aware of the condition is helpful because attending early will reduce aggravation and help manage effectively.
Osteoporosis is characterised by low bone density and micro-architectural deterioration of bone tissue, resulting in bone fragility.
Bone mineral density (BMD) measured by dual X-ray absorptiometry (DXA) is the gold standard for diagnosing osteoporosis.
The test will tell you the minerals, such as calcium, present in your bones and give you an idea of how healthy they are. They warn you if you are going towards osteoporosis and help you avoid fractures in the future by taking corrective measures.
The results are interpreted with T-scores.
Normal is between +1 and -1. If T-score is less than -2.5, it is osteoporosis. If it is between -1 and -2.5, it is osteopenia, which means, eventually, you may develop osteoporosis.
The most common anatomical regions evaluated for osteoporosis are the femoral neck, lumbar spine, and wrist or forearm.
Significance of peak bone mass in osteoporosis
Peak bone mass is the maximum bone density a person has at the end of skeletal maturity.
Bone accretion starts in childhood and reaches the peak bone mass in adulthood. Hip and spine reach peak bone mass in the early 20s. Other bones reach their peak mass by your early 30s.
Genetics has a significant impact on peak bone mass. While genetic factors have a major influence on the variance of peak bone mass, other lifestyle factors also impact how much bone mass you make.
To sum up, the peak bone mass depends on:
- Genetics (a significant factor)
- Nutrition (Nutrition adequate in calcium and vitamin D results in improved peak bone mass)
- Smoking (Lesser smoking means good peak bone mass)
- Exercise (Regular physical activities positively impact bone density)
Interestingly, a 10% increase in peak bone mass can reduce the risk of fractures by 30%!
Thus, a good peak bone mass evidently reduces the risk of osteoporosis. However, older people who have already reached skeletal maturity cannot increase peak bone mass. Nevertheless, they can still maintain bone density by following the tips in the coming sections.
Post menopausal osteoporosis – Risk factors
Risk factors that you can’t change:
Being a female and of age over 50 are significant osteoporosis risk factors. Since we are talking about post menopausal osteoporosis in women after menopause, we list the other risk factors.
- Has a small body frame: Small, thin-boned people are at greater risk.
- Family history: Does either of your parents has a history of fractures? You are more likely to develop osteoporosis.
- Ethnicity: Being a caucasian or Asian puts you at high risk for osteoporosis.
Risk factors that you can work on:
- Sex hormones
- Eating disorders such as Anorexia nervosa
- Calcium and vitamin D
Ways to improve bone density and manage post menopausal osteoporosis
As mentioned above, you can certainly improve certain aspects of your life and reduce the risk of post-menopausal osteoporosis.
The hormone estrogen plays an important role in bone metabolism. Bone metabolism is where the mature bone tissues are resorbed, and new bone tissues are formed. This process happens lifelong.
However, when the estrogen levels drop significantly during and after menopause, more bone resorption happens than formation, resulting in weak, porous bones.
Further, low estrogen levels affect calcium metabolism as well, reducing both intestinal and renal calcium absorption.
Though hormone replacement therapy (HRT) and synthetic hormones are prescribed to women with severe bone loss, the treatment is not without adverse effects. The undesirable effects include,
- Drugs may have cancer effects
- Benefits are time bound. That is, when you discontinue the treatment, deterioration of bone density bounces back
- May cause blood clots, stroke
- Further, the poor cannot afford the therapy
Instead, phytoestrogens, which are plant compounds mimicking estrogen, are particularly beneficial. Phytoestrogens are prescribed as supplements. You may also include a diet rich in phytoestrogens, such as flax seeds, soy, sesame seeds, garlic, berries, wheat bran, cruciferous veggies etc.
A diet with adequate calcium, vitamin D, and protein is crucial for bone health not only post-menopause but from the growing years. Proper nutrition will help build a good peak bone mass during your younger years and also helps maintain bone density in adulthood.
What women in perimenopausal and menopausal age must understand is that with falling estrogen levels, calcium absorption will also reduce. So, you must ensure adequate calcium (1200 mg/day) from various food sources.
Also, vitamin D deficiency will hamper calcium absorption. So, get vitamin D from sunlight, or talk to your doctor for supplements.
As you may know, 1g of protein per kg body weight is recommended for menopausal women.
While planning your diet, do take care to get the nutrients from healthy sources that are unprocessed and do not contain unhealthy fats.
The importance of physical activity is always emphasised! They are crucial for bone health and overall health at all ages.
To enhance bone health, maintain bone density and improve calcium absorption, menopausal women should do more weight-bearing exercises, such as strength training, walking, hiking, climbing stairs, jogging, etc.
4. Quit smoking
Studies confirm that smoking negatively impacts bone health. Smoking generates huge amounts of free radicals, hampers estrogen production, impedes the hormone calcitonin, and damages osteoblasts (bone-making cells), all contributing to bone loss.
5. Alcohol consumption
Excessive alcohol consumption interferes with calcium absorption and vitamin D production, reducing bone health. In addition, it can cause hormone deficiencies, including low estrogen and high cortisol levels, both contributing to bone loss.
Further, consuming alcohol can interfere with calcium absorption and vitamin D metabolism. It also negatively affects bone-building osteoblast cells.
The bottom line
The risk of osteoporosis increases with age in both men and women. However, it is more common in women after menopause. With informed lifestyle choices, you can reduce the risk of osteoporosis and lead a comfortable life.
Menopausal osteoporosis needs to be addressed seriously because it can significantly increase the risk of bone fractures, particularly in the hip, wrist, and spine. This can result in long-term pain, immobility, and decreased quality of life. Additionally, fractures in these areas can be life-threatening and increase the risk of death in older women. Furthermore, osteoporosis can substantially impact overall healthcare costs due to the cost of treatment and rehabilitation for fractures. Therefore, addressing menopausal osteoporosis is crucial for improving the overall health and well-being of postmenopausal women.