Your bone health during menopause

It is impossible to advocate for a positive perimenopause and menopause without highlighting the importance of our bone health as the two are inextricably linked.
Oestrogen and testosterone are both important for maintaining balance between bone formation and resorption so as these important hormones decline with advancing age and transition through Perimenopause to menopause, women may experience an acceleration in bone loss.

Bone loss begins at around age 30-35. Women may lose as much as 50% while men lose about 30%. But it is often a “silent disease” without symptoms until bones fracture. The only symptom you might notice is a loss of height due to fractures to the spinal bones.

This is not just an issue for women in midlife. It is important for everyone to be aware of their bone health.

There are many factors that increase our risk of osteoporosis:

⁃ premature ovarian insufficiency (POI)
⁃ surgical menopause
⁃ Prolonged absence of periods E.g. anorexia & RED-S
⁃ Breastfeeding
⁃ Hormonal treatment for breast or prostate cancer
⁃ Thyroid or parathyroid problems
⁃ Inflammatory bowel disease and Coeliac disease
⁃ Excess alcohol intake
⁃ Smoking
⁃ Poor sunlight exposure and low vitamin D
⁃ Low weight (BMI<19)
⁃ Low dietary calcium
⁃ Long term oral steroid use (E.g prednisolone)
⁃ Family history of hip fracture or osteoporosis
⁃ History of previous low energy fracture
The good news is we can all support bones health to reduce our risk by:
⁃ taking regular exercise including weight-bearing exercise (running, skipping, dancing, aerobics, walking) AND strength & resistance training  (Pilates, weight-lifting, functional training) for 30m at least 4-5 days per week.
⁃ Eating sufficient dietary calcium 700mg/day (increasing to 1000-1500mg/per day in established osteoporosis or inflammatory bowel disease)
⁃ Sources: cow’s milk, cheese, yoghurt, broccoli, kale, tinned fish, fortified plant-based alternatives and fortified cereals
⁃ Limiting alcohol & smoking cessation
⁃ Vitamin D supplementation: at least 400iu/day but often more if baseline levels are low

Talk to your doctor if you are concerned. DEXA scans are a useful test that can be used to calculate your FRAX fracture risk which helps guide what level of treatment for bone protection is best for you.

  • Calcium and vitamin D supplementation and lifestyle changes are first line
  • Bisphosphonates are often used but can only be used for a limited time.
  • Selective Oestrogen Receptor Modulators also have a role.
  • HRT significantly supports normal bone metabolism and can protect against loss the bone mineral density, osteopenia and osteoporosis and proactive use should be considered in anyone who has strong family history of other additional risk factors as mentioned above.