Your Bone Health Through Menopause Explained

Highlighting the importance of bone health is essential when advocating for a positive perimenopause and menopause. This is because they are inextricably linked. 

Sex Hormones and Bone Health

Oestrogen and testosterone both play a role in maintaining a balance between bone formation and resorption. 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 only 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. These include:

• 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

Supporting Bone Health Through Lifestyle

The good news is we can all support bone health and reduce our risk of osteoporosis through lifestyle changes. These include:

• taking regular exercise including weight-bearing exercise (like running, skipping, dancing, aerobics, walking)
• including strength & resistance training  (Pilates, weight-lifting, functional training) for 30 minutes at least 4-5 days per week
• Eating sufficient dietary calcium - 700 milligrams per day (increasing to 1000-1500mg/per day in established osteoporosis or inflammatory bowel disease) Good sources include: cow’s milk, cheese, yoghurt, broccoli, kale, tinned fish, fortified plant-based alternatives and fortified cereals 
• Limiting alcohol
• Stopping smoking
• Supplementing with Vitamin D: at least 400 IU/day(10 micrograms). More is needed if baseline levels are low

If You Are Worried About Your Bone Health

Talk to your doctor if you are concerned about your bone health. 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.  Treatment options include:

• Calcium and vitamin D supplementation and lifestyle changes as a first step
• 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. Proactive use should be considered in anyone who has strong family history of other additional risk factors as mentioned above.