As we journey through menopause, symptoms like “heavier than an elephant” heavy periods, hot flashes, and brain fog get all the buzz. However, this life change can cause other lesser-known but equally-important-to-watch-out-for symptoms, like osteoporosis. Because issues like bone loss don’t get as much attention as other common menopause symptoms, we don’t get enough information about the facts. But our bones, like the rest of our bodies, need love. The stages of menopause and decreasing estrogen might increase our chances of bone breakage, but we don’t have to just sit down and take it! Instead, we can get the low-down on all things osteoporosis and menopause, and learn what we can do to give our bones the TLC they need.
What Is Osteoporosis?
If you’re like me, then you didn’t know that the bones you have now aren’t the same ones you had 20 years ago. I blame brain fog for making me forget that particular high school science lesson. But, it’s true! Our skeletons constantly undergo a recycling process as certain bone cells break down microscopic bits of bone daily to release minerals into our blood. If we’re healthy, what gets broken down gets replaced. On the other hand, if more minerals are removed and not replaced, the result is low bone mass. And low bone mass, or porous bones, which is the definition of osteoporosis, makes us more susceptible to fractures.
Now, why would your body forget to replace those minerals? Let’s just say that it might be a little overwhelmed, ensuring what remains of your hormones gets distributed fairly in your body.
Causes of Brittle Bones
Many factors can cause osteoporosis—brittle bones or bone loss. Namely, immune system disorders, depression, inactivity, nutrient-poor diets, steroid drugs, and certain medications. But, the biggest cause is decreased hormones. Specifically, estrogen. In fact, 80 percent of the 10 million Americans with osteoporosis are women and people who were assigned female at birth and/or who have female hormones.
According to the Bone Health and Osteoporosis Foundation, women are far more likely to develop osteoporosis than men for two reasons:
- Estrogen has bone-protecting qualities that drop off sharply when women reach menopause.
- Because they tend to have smaller, thinner bones than men.
Note that osteoporosis is most prominent in people who have hit or surpassed menopause. So those 8 million women (and people who were assigned female at birth and/or who have female hormones) with osteoporosis? None of them are in perimenopause. Therefore, if you’re still in that first of the three stages of menopause, then yay! You’ve got time to prepare! If you’re in the second or third stage (menopause or postmenopause), then don’t despair. You’ve got options.
What Does Osteoporosis in Menopause Look Like?
Osteoporosis during the menopausal journey can look different in every person. Its symptoms, especially in the beginning, are rare and hard to detect.
Bone Loss Symptoms
Here are some signs that indicate potential bone loss:
- Receding gums: Your gums can recede if your jaw is losing bone.
- Weaker grip strength: Researchers have found that low handgrip strength can be linked to low bone mineral density.
- Weak and brittle fingernails: Poor nail strength can signal poor bone health. [source]
Later-Stage Osteoporosis Signs
Later-stage osteoporosis is a little more obvious, with signs like:
- Loss of height
- Fracture from a fall
- Back or neck pain
- Stooped posture
Unfortunately, osteoporosis’ worst-case scenario is that it increases your risk of disability or death. According to a 2017 study, hip fractures are associated with a 15 to 20 percent increase in mortality within a year.
Is Osteoporosis Preventable?
Here’s the good news, and it’s very good news: osteoporosis is preventable. Not just pretend-it-doesn’t-exist preventable, but wholly and completely preventable. And you know what else? Undergoing menopause doesn’t guarantee you’ll develop osteoporosis either. It’s not a death sentence, by any means. In fact, as Dr. Christiane Northrup puts it in her book The Wisdom of Menopause:
It’s important to remember that healthy women can lose some bone during menopause and not be at risk for fracture if their bone quality is good. Thousands of people walk around daily with very low bone-density—yet only a small percentage of them experience fractures.
In fact, for the very reason that bones are constantly changing, even in menopause and beyond, that means there’s always something you can do.
How Do I Prevent Osteoporosis?
Prevention of osteoporosis means strengthening your bones to reduce the risk of fracture and improving your bone health, including:
- Do weight-bearing exercises, like climbing stairs. Amanda Thebe’s book Menopocalypse has some good suggestions for specific kinds of exercises.
- Eat a balanced diet high in fruits, vegetables, calcium, and vitamins.
- Take 1,200 mg of calcium daily, dividing doses into 250-500 mg portions throughout the day. Check with your doctor first about how much you should take. Too much calcium can increase the chance of kidney stones. Also, even if you drink lots of milk, it’s likely still not enough to get you to that 1,200 mg mark.
- Take vitamin D because it helps your body absorb calcium. The North American Menopause Society and the National Osteoporosis Foundation recommend at least 800-1000 IU per day for women age 50 and over who are at risk of vitamin deficiency (because they live in northern latitudes, for example).
- Avoid alcohol and smoking. Women smokers tend to lose bone more rapidly and have lower bone mass than nonsmokers.
- Take a prescription medication to prevent bone loss.
Do I Need to Get Tested to Determine My Bone Health?
Want more good news? Just because you’re in the menopause life phase doesn’t mean you need to run out and get tested for osteoporosis right away.
Osteoporosis Tests: Recommended Age and Risk Factors
Healthcare practitioners likely won’t recommend bone tests until age 65 and only if you have more than one risk factor, including:
- Family history of osteoporosis
- Caucasian race
- Poor health
- Going through menopause before age 45
- Having ovaries removed before age 45
- Drinking alcohol frequently
Situations That Merit Earlier Bone Density Testing
However, what happens if you do need to get tested? For example, I take medication that puts me at high risk for osteoporosis. When I turned 50, I asked my doctor if I could get tested to stay on top of my bone health. And he was happy to oblige. But, my circumstances might be different than yours. For instance, I knew from the age of 16 that osteoporosis may someday rear its ugly head in my life, so I’ve had a long time to get educated. But, what if you don’t know whether it’s a reality or a possibility for you?
According to Healthline, certain medical conditions can also make you more prone to developing osteoporosis:
- Kidney failure
- Vitamin D deficiency
- Rheumatoid arthritis
- History of breast cancer
- Cystic fibrosis
- Sickle cell disease
- Malabsorption due to inflammatory bowel disease or celiac disease
Lastly, some immunosuppressants, seizure medications, and thyroid replacement therapies (if the dosage is too high) can also increase your risk. However, keep in mind that risk is not the same as having an it’s-going-to-happen-tomorrow-and-there’s-nothing-you-can-do-about-it mindset.
The long and short of it is that, if you have more than one of any of the risk factors or medical conditions listed above, or are taking any of those medications, you’ll want to get tested. Do it during perimenopause to get a baseline of your bone density. If you have insurance, check with your provider to ensure they’ll cover the test.
What Are the Tests for Osteoporosis?
If you suspect or find that you need to get tested, either due to the situations listed above or because of a bone fracture, here are the following test options:
- Bone mineral density (BMD) test, which is an x-ray that uses very small amounts of radiation to determine bone strength
- Dual-energy bone densitometry (DEXA), which is similar to the BMD
- Fracture Risk Assessment Tool (FRAX), which takes into account
- Your age
- Whether you’re a smoker or non-smoker
- Your family history of hip fracture
- Glucocorticoid (e.g., Prednisone) use
- Femoral neck bone mineral density
- Pyrilinks-D, CTX, or Osteomark, which are urine tests for bone breakdown products. Another thing to add to your list of things you learned today: your pee can indicate your bone strength. As bone breaks down, it releases minute fragments of collagen into your urine. If you’ve got too much collagen in your pee, you’re more likely to have low bone mass.
If you see early signs of osteoporosis or experience a fracture, talk with your doctor, share your symptoms and concerns, and work together to determine which test is best for you. Most importantly, adopt the “prevention is better than cure” approach by following the steps listed in the “How Do I Prevent Osteoporosis” section above.
What Are the Treatments for Osteoporosis?
If you do develop osteoporosis, which is usually diagnosed after a fracture, you’ve got good treatment options there too. They start with medications that either prevent or treat osteoporosis and fracture. These include the following:
- Bisphosphonates: These medications slow down bone loss and improve the overall quality of your bones. They do this by helping your body to build new bone at around the same rate that it loses it.
- Selective estrogen receptor modulators (SERMs): This is a class of drugs that acts like estrogen in bone tissue, helping to build it up again. It also has certain anticancer properties.
- Calcitonin: This is a hormone that your body makes naturally that helps control your calcium levels.
- Denosumab: This is a monoclonal antibody (a drug that targets only certain cells in the body) that can reduce the risk of fractures.
- Anabolic agents: These drugs contain a synthetic form of a natural hormone called PTH. They stimulate your body to build new bones.
- Estrogen Replacement Therapy or Hormone Replacement Therapy (HRT): This is hormone-based therapy to replace your declining estrogen and other hormones.
What Role Can ERT or HRT Play in Osteoporosis?
Dr. Pauline M. Camacho, Professor of Medicine and Director of the Loyola University Osteoporosis Metabolic Bone Disease Center, says, when talking about the benefits and risks of estrogen treatment:
Though estrogen replacement therapy [alone] was once the only approved osteoporosis medication, it is not as widely used today. Part of the reason for this is because the therapy has been connected to increased risks of uterine cancer, breast cancer, stroke, heart attacks, blood clots, and even mental decline.
Remember that ERT is not the same as Hormone Replacement Therapy (HRT). ERT is just estrogen replacement. But since estrogen isn’t the only hormone to go bye-bye during menopause, and because progesterone mitigates the risks of estrogen alone, says Dr. Camacho, most doctors will prescribe some form of progesterone along with estrogen therapy. If estrogen alone is prescribed for bone loss in post-menopausal women, it is usually prescribed at the lowest dose possible for the shortest amount of time possible.
So, if you take estrogen to strengthen your bones after a fracture, make sure to consider its benefits and risks in light of your own special circumstances.
It’s a Wrap!
Osteoporosis may be one of the more silent symptoms during the menopausal journey but it doesn’t have to be deadly. Proactively doing things to strengthen your bones, like exercising and taking calcium and vitamin d, can head osteoporosis off. And, if you develop the disease, you’ve got plenty of medications to treat it, including bisphosphonates, anabolic agents, and hormone replacement therapy. Altogether, showing your bones some love shows you some love, and that’s a very good thing!
- Northrup, C. (2021). The Wisdom of Menopause: Creating Physical and Emotional Health During the Change. Bantam Books.
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