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. Below, we’ve covered the basics you need to know about how menopause affects your bone health.
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.
Estrogen and menopause
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
- Anorexia nervosa (Steinman, 2019)
- Inadequate intake of calcium and low vitamin D level
- Having undergone bariatric surgery (Stein, 2014) or malabsorption
Knowing these risk factors – especially those that can be changed with lifestyle adjustments – may help you avoid or slow the progression of osteoporosis. 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. Incorporating the right types of exercises is one of the most effective lifestyle adjustments you can make to build strong bones.
Maintaining your bone strength during and after menopause
As mentioned, 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. A proper bone-health exercise program such as Wellen, which includes exercises specifically designed to build bone, is a great preventative measure one can take to build and maintain bone.
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. Incorporating regular exercise and proper nutrition into your lifestyle can play a significant role in preventing osteoporosis. 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. 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.
By taking a proactive approach to your bone health, 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.