Dr Deborah Lee – Your Bone Health, Osteoporosis, and Menopause

Osteoporosis – A Shock Diagnosis

It comes as a nasty shock when you first find out you have osteoporosis.

Osteoporosis has no symptoms – until that first fracture occurs. Women are horrified to find their bones have been silently crumbling.

I remember my grandmother dying with her chin quite literally welded to her chest due to osteoporosis in her cervical spine, and physically unable to eat or swallow food.  I never realised, sitting there on her bed, that one day this might happen to me.

What Happens To The Skeleton At Menopause?

When you go through the peri-menopausal transition, around age 50-55, your estrogen levels fall by an incredible 90%.  At the same time, your bone mineral density (BMD) is reduced by 10%. 1 in 4 women, lose 20% of their BMD,  so-called ‘fast bone losers.’  Bone loss continues after this but at a slower rate.

Here’s the problem. Once such dramatic bone loss has occurred, it’s impossible to restore it. You are now at an increased risk of a fracture, a problem which can only worsen with age. The diagnosis of osteoporosis heralds the misery of pain, deformity, loss of function, loss of height, loss of mobility, loss of independence – and sadly, death.

Why Does The Menopause Cause Loss Of Bone Mineral Density?

Bone density is a measure of the strength of the bone and its ability to fracture.

Bone is a living tissue. New bone cells are being constantly produced and dead bone cells are being cleared away. This process is a fine balance and is highly dependent on estrogen.

When estrogen levels fall at menopause, this balance is upset. There is a reduction in new bone cell production and an increase in bone cell clearance, meaning the bone becomes less dense, is weakened and more susceptible to fracture.

Calcium is the major constituent of bone. However, many menopausal women have an inadequate dietary intake of calcium. To make matters worse, calcium absorption from the gut becomes less efficient with ageing.

Absorption of calcium from the gut requires vitamin D. Many studies have reported low vitamin D levels in peri and postmenopausal women, for example, in one Danish study of perimenopausal women, aged 45-48 years, not taking HRT, the prevalence of vitamin D deficiency in the winter months was 32.8%.

What Can I Do To Help My Bones?

The most important thing is not to do nothing!

 

  • See Your GP – Ask for a bone health review and a DXA bone scan. This is the best test to measure your BMD. You cannot accurately assess BMD on an x-ray.

The doctor will assess your risks and may suggest blood tests to check your calcium, phosphate, and vitamin D levels.

  • Use The Frax Tool – This is a special calculation which combines your personal risk factors and bone mineral density to give a percentage likelihood of a major fragility fracture within the next 10-years.

 

  • Diet – Calcium 1200 mg/day from all sources, along with 800 -1,000 IU of vitamin D for women over 50, is currently recommended. (National Osteoporosis Society 2020).  As this is often impossible by dietary means, women are recommended to take calcium and vitamin D supplements. Spread out your calcium in-take throughout the day.

You need to eat a healthy balanced diet, high in protein, full of fruit and vegetables, with foods containing high levels of magnesium and zinc. Avoid very low-calorie diets, which have been linked to osteoporosis.

Consider taking a collagen supplement.

 

  • Stop Smoking – Smoking has a major negative influence on bone health. Female smokers have a 31% lifetime increased chance of a hip fracture. Stopping smoking is the best way you can improve your bone health.

 

  • Reduce Your Alcohol Consumption – Alcohol also increases the risk of poor bone health and fracture risk.

 

  • Make Changes At Home To Reduce Your Risk Of Falls – Avoid clutter, use nonslip mats under rugs and carpets, have good lighting, wear proper shoes, not slippers. Take advice on how to reduce the risk of falls.

 

Medical Treatments For Oeoporosis

Drug treatments for osteoporosis include medication such as alendronic acid, denosumab, and strontium ranelate. These can be highly effective in reducing future fractures. Find out more from GP. You may need to see a Consultant Rheumatologist before being prescribed these drugs.

 

What About HRT?

Estrogen replacement in HRT has long been known to prevent menopausal bone loss and reduce the risk of fracture. However, it needs to be started within the ‘window of opportunity’ – the time period soon after menopausal symptoms begin – for 5-10 years. Starting HRT over age 60, if you have never taken it before, can pose small risks. Older women with poor bone health are often prescribed alternative osteoporosis treatments.

 

Final Thoughts

There is no quick fix to boost your skeleton! However, if you understand what is happening to your bones, there are plenty of ways you can take action to keep your bones as well as they can be and reduce your chance of fracture.

 

About The Author

Dr Deborah Lee has worked for many years in the NHS, mostly as Lead Clinician within an integrated Community Sexual Health Service. She now works as a health and medical writer, with an emphasis on women’s health. Dr Lee is a medical content writer for Dr Fox (Dr Fox Online Pharmacy).

Dr Lee writes for many media outlets including The Sun, The Daily Express, Bella magazine, Red magazine, Cosmopolitan, Net Doctor, and many more. She remains passionate about all aspects of medicine – including obesity, weight loss, diet, and nutrition.

After qualifying from University of Southampton Medical School in 1986, Dr Lee trained as a GP and after a number of years specialised in Sexual & Reproductive Health (S&RH).

Sexual And Reproductive Health Specialist, Medical And Healthcare Writer, BM, MFFP, MRCGP, DRCOG, Dip GUM, Dip Colp, LOC Med Ed GMC no. 3129913.

 

For More Information

NHSOsteoporosis

Open Access GovernmentCalcium supplements for postmenopausal women

Effect Of Estrogen On Bone

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5643776/

denosumab

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426099/#:~:text=Denosumab%20causes%20an%20increase%20in,and%20up%20to%208%20years.

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