Osteoporosis and menopause – the facts
It’s true that oestrogen levels drop during menopause, and that this is linked to bone loss. But, contrary to what many women fear, it doesn’t mean that osteoporosis and menopause go hand in hand. BeingEve spoke to Sarah Leyland, osteoporosis nurse consultant at the National Osteoporosis Society in the UK, for the full facts.
Menopause isn’t automatically the time to seek out tests and treatments for osteoporosis but it is a good time to think about your risks and consider simple lifestyle changes to keep your bones stronger for longer.
“Things have changed quite a bit,” explains Sarah Leyland, osteoporosis nurse consultant at the National Osteoporosis Society. “At one time it was said every woman at menopause needed hormone replacement therapy to prevent osteoporosis.
“Now it’s more about focusing on people who are at high risk of bone fracture and for the rest of us it’s about seeing menopause as a time to take stock and think about lifestyle.”
Here’s the lowdown on what bone density loss actually means, when you may be at genuine risk of osteoporosis – aka weak bones – and how to protect your bone health for many years to come.
What is the link between osteoporosis and menopause?
Women may lose as much as 20 per cent of their bone density in the five to seven years post-menopause, according to www.nhs.uk. This is caused by falling levels of the female hormone oestrogen, which helps to protect bone strength.
But, while bone density may decrease, your actual risk of breaking bones because of osteoporosis generally stays pretty low until you are well into your 70s and beyond.
For the majority of women, going through menopause does not mean you will have fragile bones. But it does signal a time to take stock, and think about whether your lifestyle needs a shift. “It’s one of those phases in women’s lives when it’s a good moment to take an overall view and to adopt a healthy lifestyle, and think about whether you have key risk factors that need addressing” says Sarah Leyland.
Take up weight bearing and resistance exercise
Being active is good for us all, and when thinking about bone strength it’s important to factor weight bearing and resistance exercises into your routine.
Weight bearing exercise – any exercise in which you are supporting your own body weight through your hands and feet – might include jogging, boxercise, walking, tennis and dancing.
Resistance exercises would be strength training, such as weights – but if you are a newbie, make sure you begin under proper supervision from an instructor. The National Osteoporosis Society recommends strength training three times a week on non-consecutive days.
Do I need supplements?
“There’s nothing about menopause that says you suddenly need to take a supplement,” says Sarah Leyland. “We’ve moved away from just shouting about calcium, to saying you just need to eat really healthily with food from all the main food groups. You need a good balance of nutrients.”
Within that healthy diet we should be getting 700mg of calcium a day, she adds. Good sources include dairy, almonds, sardines, curly kale, sesame and soya.
And we should all be getting a mix of the fruit and vegetables, proteins, carbohydrates, dairy and alternatives that make up a balanced diet.
Getting enough Vitamin D
Vitamin D helps to regulate the way our bodies use calcium and ensure our bones remain strong. Good dietary sources include oily fish and eggs, although we get the majority of our Vitamin D through sunlight.
Sensible sunlight exposure would be 10 minutes twice a day without sunscreen, between March and September. New advice from Public Health England has stated that we need to get some vitamin D from our diet or from supplements to be on the safe side (10 micrograms daily). (Vitamin D supplements may be sensible during the winter months when our climate is gloomier and vitamin D isn’t available from sunlight exposure.
Cutting back on alcohol
Excessive alcohol consumption is a risk factor for osteoporosis – try not to drink more than the Government’s limit of 14 units of alcohol per week, spread over three or four days. That translates to a maximum of six 175ml glasses of wine or six 4% alcohol by volume pints of beer per week.
Who is at high risk of osteoporosis?
There are some conditions that lead to a higher risk of developing osteoporosis and having fragility fractures, and if any of these apply, you should book an appointment with your doctor for a bone health assessment. These include:
• Premature menopause, before the age of 40
• Early menopause, before the age of 45
• Taking high doses of corticosteroids for a pre-existing condition
• Being underweight
• Having recently broken or fractured a bone
• Having a parent who has broken a hip
• Having Crohn’s or Coeliac disease
Take the National Osteoporosis Society ‘Are You At Risk’ online quiz to find out if you need to seek further medical advice https://stopatone.nos.org.uk
What are the signs of low bone density?
“There are no signs or symptoms of low bone density,” says Sarah Leyland. “What there are, are signs that you might have had little fragility fractures – bones that break easily.” Suggestions that you may have had one in your back could be height loss or curvature of the spine – although these may also be caused by other conditions, so see your doctor to check.
Do I need a bone density scan?
If you do not qualify as high risk and have had no signs of fractures, even if you are going through the menopause it is usually not necessary to have a bone mineral density scan (one type you may have heard of is DEXA, or ‘dual energy X-ray absorptiometry’). Current NICE (National Institute for Health and Care Excellence) guidelines say otherwise healthy women should have a bone health assessment at 65 and older.
Having a scan unnecessarily may lead to confusion, adds Sarah Leyland. “They technically diagnose ‘osteoporosis on a scan’, so once your bone density falls below a certain level compared to average you are assessed to have osteoporosis. That’s where people get a little confused because they think that means they’ve definitely got really fragile bones and they need a treatment and they’re going to break bones any minute, but it’s more complicated than that. “
Even if you have low bone density at 50, she adds, absolute risk of fracture is still not going to be as high as when you are 80 – partly because we fall more as we get older, but also because a bone density scan only measures the quantity of the bone, and not the quality. “Although the bone is thinner you can’t quite see what all the struts inside are doing. Even if you’ve got low BMD, it’s still likely the quality of the bone will be intact when you’re 50.”
Adds Sarah: “So rather than ‘do I need to have a bone density scan?’ it’s more about ‘when do I need to go and talk to my doctor and have an assessment about bone density health?’ The doctor will look at you as a whole and scan you if you need it.”
Read our readers own experience and top tips to help avoid it.
For more information on osteoporosis see www.nos.org.uk or call their helpline on 0808 800 0035.