What You Need to Know About Menopause and Osteoporosis

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Each year, about 1.3 million women will enter menopause (Peacock, 2022). Yet, most women don’t know about the impact menopause has on their bone health. Menopause, the cessation of the menstrual cycle for at least 12 months, leads to a decrease in the hormone estrogen, which can result in bone loss and increase the risk for developing osteoporosis. In this article, we cover the basics you need to know about how menopause affects your bone health. 

Disclaimer: If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Well Guide contain information from peer-reviewed research, medical societies and governmental agencies; however, these articles are not a substitute for professional medical advice, diagnosis, or treatment.

How does estrogen affect bone health?

While most people think about their bones as a static, hard material, they actually are a living tissue that is constantly changing. Even as you are reading this, your bone tissue is actively building up and breaking down. 

Estrogen plays a part in this process. It helps regulate certain bone cells, which are responsible for building and breaking down bone tissue (Cheng, 2022). Specifically, estrogen helps maintain the activity of osteoblasts, which are responsible for building new bone, while inhibiting the activity of osteoclasts and osteocytes, which remodel and break down bone tissue (Khosla, 2012). For this reason, estrogen is an integral part of bone health. 

How does menopause affect bone health?

Now that you know estrogen affects bone health, you might be wondering what happens during menopause when estrogen levels decrease. Because estrogen plays an important role in bone formation, when the amount of estrogen produced by the body decreases during menopause, this can lead to a decrease in bone density (Karlamangla, 2018). This is because decreasing estrogen during menopause leads to increased bone breakdown and decreased bone formation (Khosla, 2012). During the years around your last period, bone is broken down faster than at any other point in your life (Greendale, 2012). Estrogen is essential for strong bones, but as levels decline after menopause, bone loss accelerates, which can lead to osteoporosis. 

Menopause and osteoporosis

Osteoporosis occurs when your body loses too much bone mass and/or doesn’t accumulate enough bone tissue (Bone Health and Osteoporosis Foundation). It is one of the most common bone diseases, causing the structure of your bones to change and become more vulnerable to breaking. 

Usually, a bone break (also known as a fracture) results from a fall or sudden impact. If you have osteoporosis, the same fall or impact that would not normally cause a fracture in someone with a normal bone density may lead to fractures (Oostwaard, 2018). Osteoporosis is often called a “silent disease.” Unfortunately it’s not until a bone break occurs that many women are even aware of their diagnosis of osteoporosis, as the subtle warning signs (loss of height, increased thoracic kyphosis or curvature) often go unnoticed.  

Menopause and aging are the primary causes of osteoporosis, but not the only culprits. Secondary osteoporosis can result from other underlying causes such as many chronic medical conditions, including rheumatoid arthritis, diabetes, high calcium levels (hyperparathyroidism), an overactive thyroid disease, and/or eating disorders and malabsorption. It can also be caused by certain medications or treatments, such as steroids, anticoagulants and antiseizure medications (Sobh, 2022).

Aside from the factors mentioned above, other modifiable and nonmodifiable risk factors that can increase your odds of developing osteoporosis include:

  • Female gender
  • Race: Non-Hispanic white and Asian women are more likely to develop osteoporosis (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2022)
  • Family history: Having a parent or sibling with osteoporosis, or a parent who fractured a hip
  • Previous history of broken bones
  • Body frame size: People with smaller body frames face a greater risk due to less initial bone mass (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2022)
  • Lower body mass index (BMI)
  • History of breast cancer: Treatments for breast cancer (such as aromatase inhibitors) can cause bone loss and lower bone density (Vestergaard, 2020)
  • Cigarette smoking
  • Excessive alcohol intake
  • Inactivity
  • Anorexia nervosa (Steinman, 2019
  • Inadequate intake of calcium and low vitamin D level
  • Having undergone bariatric surgery (Stein, 2014) or malabsorption

Reducing your risk of osteoporosis after menopause

Knowing the risk factors for osteoporosis – especially those that can be changed with lifestyle adjustments – may help you avoid or slow the progression of osteoporosis after menopause. While some risk factors for osteoporosis are unavoidable (gender, race, family history), there are many lifestyle changes that you can make (exercise, nutrition and reducing/limiting alcohol/smoking habits) to help strengthen your bones.

Your bones are an active tissue. Just like muscles that can be built up or shrink with use, so can your bones. There are ways to prevent osteoporosis or maintain and even reduce bone loss regardless of what stage of life you are in. Of course, the earlier you begin taking steps towards improving your bone health, the better, but the good news is that it’s never too late to maintain and build bone.

Exercise and bone health

Incorporating regular exercise into your lifestyle can play a significant role in preventing osteoporosis after menopause. Weight-bearing and resistance exercises such as walking and strength training can help strengthen bones and improve overall bone health (Daly, 2018). Balance and posture exercises can help keep you upright and prevent falls. A proper bone-health exercise program such as Wellen, which includes exercises specifically designed to build bone and prevent falls, is a great preventative measure one can take to build and maintain bone.

Nutrition and bone health

Additionally, ensuring a diet rich in calcium, vitamin D, and other bone-healthy nutrients can further support your bone (and general) health.  If you have inadequate calcium intake, calcium supplementation will be recommended to achieve 1200 mg calcium daily, from diet and supplement combined. Vitamin D supplements may be recommended if you have a low Vitamin D level.  

Other lifestyle changes

Other lifestyle changes can also have a positive impact on your bone health. Quitting smoking and avoiding excessive alcohol consumption can contribute to better bone density, as these habits can weaken bones over time. Additionally, avoiding a sedentary lifestyle by staying active and participating in weight-bearing activities during the day is essential. Lastly, focusing on posture and practicing balance-enhancing activities such as tai chi can reduce your risk of falls and fractures. By integrating these lifestyle adjustments, individuals can take proactive steps towards maintaining strong and resilient bones throughout their lives.

Menopausal hormone therapy

Menopausal hormone therapy (MHT) is another valuable asset in promoting bone health during and after menopause. Beyond its well-known role in alleviating menopausal symptoms, MHT (also known as hormone replacement therapy or HRT) can have a positive impact on bone health. Estrogen plays a crucial role in maintaining bone strength, but estrogen hormone levels drop significantly during menopause. MHT helps mitigate the accelerated bone loss that often accompanies this hormonal shift, reducing the risk of fractures. However, it's important to keep in mind that the decision to pursue MHT should be individualized, considering factors such as your overall health, medical history, and preferences. Consulting with a healthcare professional to weigh the potential benefits and risks of beginning MHT will help you and your doctor make an informed decision about whether or not to incorporate MHT into a comprehensive approach to preserving bone health during the menopausal years.

By taking a proactive approach to your bone health after menopause, you can ensure a better quality of life and improved overall wellbeing and reduce your risk of fractures in the future. Now is the time to prioritize your health and take the next steps to improve your bone health.

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  1. Peacock K, Ketvertis K. Menopause. StatPearls Publishing. 2022. Treasure Island, FL.
  2. Cheng CH, Chen LR, Chen KH. Osteoporosis Due to Hormone Imbalance: An Overview of the Effects of Estrogen Deficiency and Glucocorticoid Overuse on Bone Turnover. Int J Mol Sci. 2022;23(3):1376. Published 2022 Jan 25. doi:10.3390/ijms23031376
  3. Khosla S, Oursler MJ, Monroe DG. Estrogen and the skeleton. Trends Endocrinol Metab. 2012;23(11):576-581. doi:10.1016/j.tem.2012.03.008
  4. Karlamangla AS, Burnett-Bowie SM, Crandall CJ. Bone Health During the Menopause Transition and Beyond. Obstet Gynecol Clin North Am. 2018 Dec;45(4):695-708. doi: 10.1016/j.ogc.2018.07.012. Epub 2018 Oct 25. PMID: 30401551; PMCID: PMC6226267.
  5. Greendale GA, Sowers M, Han W, et al. Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: results from the Study of Women's Health Across the Nation (SWAN). J Bone Miner Res. 2012;27(1):111-118. doi:10.1002/jbmr.534
  6. What is Osteoporosis and What Causes It? Bone Health and Osteoporosis Foundation. N.d. Accessed March 29, 2023. https://www.bonehealthandosteoporosis.org/patients/what-is-osteoporosis/ 
  7. Hertz K, Santy-Tomlinson J, editors. Fragility Fracture Nursing: Holistic Care and Management of the Orthogeriatric Patient [Internet]. Cham (CH): Springer; 2018. PMID: 31314236. https://pubmed.ncbi.nlm.nih.gov/31314236/ 
  8. Sobh MM, Abdalbary M, Elnagar S, et al. Secondary Osteoporosis and Metabolic Bone Diseases. J Clin Med. 2022;11(9):2382. doi:10.3390/jcm11092382
  9. Osteoporosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH. December 2022. Accessed March 29, 2023. https://www.niams.nih.gov/health-topics/osteoporosis
  10. Vestergaard P. Drugs Causing Bone Loss. Handb Exp Pharmacol. 2020;262:475-497. doi: 10.1007/164_2019_340. PMID: 31889220.
  11. Steinman J, Shibli-Rahhal A. Anorexia Nervosa and Osteoporosis: Pathophysiology and Treatment. J Bone Metab. 2019;26(3):133-143. doi:10.11005/jbm.2019.26.3.133
  12. Stein EM, Silverberg SJ. Bone loss after bariatric surgery: causes, consequences, and management. Lancet Diabetes Endocrinol. 2014;2(2):165-174. doi:10.1016/S2213-8587(13)70183-9
  13. Daly RM, Dalla Via J, Duckham RL, Fraser SF, Helge EW. Exercise for the prevention of osteoporosis in postmenopausal women: an evidence-based guide to the optimal prescription. Braz J Phys Ther. 2019 Mar-Apr;23(2):170-180. doi: 10.1016/j.bjpt.2018.11.011. Epub 2018 Nov 22. PMID: 30503353; PMCID: PMC6429007.

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