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Bone health during menopause: Tip to combat osteoporosis after menopause

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Menopause is a natural biological process that happens to women as they age. A woman is said to have reached menopause if she has not had her periods for more than 12 months. Before she reaches menopause, she may experience several symptoms such as changes in her menstrual cycle, perimenopausal bleeding, hot flashes, and premenopausal osteoporosis symptoms. This is called the menopausal transition. or perimenopause.

Perimenopause usually hits women between the ages of 45 years and 55 years and lasts for 7-14 years. Menopause can also be triggered by a hysterectomy or removal of the ovaries.

During perimenopause or the menopausal transition, the bone health of women is also greatly affected. In this article, we will look more closely at the impact of menopause on your bones as well as how to minimise this impact.

As mentioned above, menopause marks the end of periods in a woman. But what does that really imply? How are menopause and osteoporosis linked?

When a woman enters menopause, the oestrogen and progesterone levels in her body begins decreasing. This is said to speed up bone loss and increase the risk of osteoporosis significantly. Some studies show that up to 20% of bone loss can occur during menopause.

What is osteoporosis?

As the name suggests, osteoporosis is a bone disorder characterised by low bone mass and weaker bones. As a result, the patient is more susceptible to fractures. It can be caused by several factors, even the use of certain medications. Corticosteroids and osteoporosis mechanisms are a clear example of the impact of medications on this condition. Corticosteroids are medications used to manage and treat inflammation in the body, prolonged use of this medication is said to lower the body’s ability to absorb calcium while also increasing the rate of bone resorption.

Studies also indicate that osteoporosis in women is far more common than in men, raising the question “Why are women more prone to osteoporosis?”

Osteoporosis was considered to be a silent disease, as it is usually detected only after the first fracture. Today, knowing the increased risk of postmenopausal fractures, women can opt for a variety of screening, assessment and treatment options and manage postmenopausal osteoporosis effectively.

Initially, osteoporosis was diagnosed if a fracture occurred with little or no trauma/force. Diagnosis can also be done using a dual X-ray absorptiometry (DEXA) scan. This helps define the patient’s bone mineral density. The unit used is called a T-score. The guidelines established by the world health organisation state that a T-score between −1 and −2.5 indicates low bone mass (not low enough for osteoporosis) and a T-score of −2.5 or lower indicates osteoporosis. The severity of osteoporosis is determined by the negative T-score.

How is osteoporosis managed post-menopause?

There are several treatments available to reduce the risk of fractures due to osteoporosis. The treatments are designed to either reduce resorption of the bone or increase rate of bone formation. The treatment protocols depend on your general health as well as the suitability of the medication.

Hormone replacement therapy for osteoporosis (or HRT) has also been shown to have a positive impact on bone health after menopause. Postmenopausal osteoporosis pathophysiology indicates that the cause of decreasing bone density is directy related to decreasing oestrogen levels. Hence, the treatment involves maintaining the hormonal balance in the body with oestrogen replacement therapy for osteoporosis.

Oestrogen therapy for osteoporosis has shown promising results and is also associated with several benefits apart from bone health.

Functional medicine approach to treat and manage osteoporosis involves the use of calcium supplements after menopause as well as vitamin D supplements  to maintain bone density after menopause.

Menopause and osteoporosis: Can lifestyle changes help in maintaining better bone health?

Lifestyle both before and after menopause plays a significant role in maintaining good bone health. Dr Anjali Kumar, leading gynaecologist and obstetrician in Delhi NCR offers an insight into healthy lifestyle practices that can both reduce the risk and impact of osteoporosis after menopause.

Mind your posture to minimise stress on bones

Maintaining the correct posture while sitting, standing or performing any physical activity (as simple as picking something from the ground) is one of the key factors deciding bone and joint health later on in life. Today, with our increasingly sedentary lifestyle, incorrectly sitting in one place for more than 6-8 hours every day, can cause irreparable damage to our bones over time. So pay attention to how you sit, stand, run etc, regardless of how old you are. It is never too early to start protecting your bones. 

Exercise regularly to build muscle & bone strength

Exercise plays an important role in preventing many bone and joint-related problems such as arthritis and slip-discs. 

  • Muscle and bone-strengthening activities are designed to impact and strengthen specific parts of your body at a time. For your exercise routine make sure that you cover the following three types of exercises for the best results. 
  • Weight-bearing exercises basically refer to exercises that require carrying your body weight. These include activities such as brisk walking (with weights if necessary), jogging, lunges, jumping etc. Physical activities such as swimming are good for improving cardiac function but are not considered weight-bearing exercises as it reduces the weight you carry during the activity(due to being immersed in water). 
  • Strength training exercises include the use of resistance machines such as bands, free weights or barbells. These target specific muscle groups to strengthen them. For example, to strengthen your back, you should perform spinal extension stretches. 

Balance work should be done with care, especially if you are suffering from osteoporosis. These include exercises such as yoga, pilates etc. They are designed to improve muscle stability and strength. 

You should aim to exercise at least 45-60 minutes every week to maintain healthy bones.

Change your diet to reduce menopause symptoms

Follow a healthy balanced diet to minimise the impact of menopause of bone health with food rich in vitamins, minerals and other nutrients known to promote tissue growth and regeneration. Osteoporosis pathophysiology is characterised by a reduction in skeletal mass caused by an imbalance between bone resorption and bone formation with age. It is important to increase your calcium intake to tackle this imbalance, either through natural sources or supplements. Dairy products, green leafy vegetables, soya beans, sardines, salmon etc are all rich sources of calcium.

Getting sufficient vitamin D is also essential for bone health, as it is vital for calcium and phosphorus absorption in the body. It can be taken as a supplement but is also produced in the body naturally when exposed to sunlight. Supplements should be taken by individuals who have very limited exposure to natural sunlight.

Final thought

One of the most important things to keep in mind is that the earlier you start strengthening your bones, the lower the risk of developing osteoporosis later on in life. Studies show that bone regeneration happens rapidly till the age of 30, post which the rate of regeneration decreases significantly. Women are at a greater risk of developing osteoporosis, as a result, they should start performing strengthening exercises early in their life. This will not only strengthen their muscles, offering better support to their bones but also help in preventing falls later on in life. 

To conclude, bone health is something many of us overlook, especially when we are younger. The truth is that making an effort when our bones give us the least amount of trouble will save us a lot of pain later in life.

Also, read: Can you prevent osteoporosis by just increasing your calcium intake?

FAQs

Ques: How does menopause cause osteoporosis?

Ans: Perimenopausal women are known to be at a higher risk of developing osteoporosis as this condition is directly linked to oestrogen deficiency (as occurs during menopause).

Ques: Can early menopause cause osteoporosis?

Ans: Studies show a direct link between the lack of oestrogen and osteoporosis. Early menopause (as defined as menopause before the age of 45 years) and prolonged periods of low hormone levels and absent menstrual periods can also result in loss of bone mass. 

Ques: How to increase bone density in menopause?

Ans: Bone density in menopause can be increased with calcium & vitamin D supplements and hormone replacement therapy as advised by the doctor. Regular weight bearing exercises can improve muscle strength to offer better support to bones and joints. 

Ques: How is osteoporosis treated during menopause?

Ans: Osteoporosis in menopause is typically treated with a customised exercise regimen, calcium rich diet, vitamin supplements and oestrogen replacement therapy.

To know more about managing menopause and osteoporosis and minimising its impact in our daily life, you can speak to Dr Anjali Kumar – Director of obstetrics and gynaecology at the CK Birla Hospital.