Menopause and its hormonal changes bring a host of uncomfortable and disconcerting symptoms. Hot flashes, sleep disturbance, and emotional roller coasters command much of our attention. However, a silent malady may be lurking unseen, wreaking havoc on our very foundation: our bones.
If you are a woman over 50 and/or past menopause, you may be at risk for osteoporosis. Even in the years leading up to the last period, some women lose up to 10 percent of their total bone mass. Healthy bones are living tissue, maintaining a dynamic balance between bone creation and bone loss. This balance is disrupted with the decreased estrogen that occurs in the menopause transition and afterward. Increasing bone loss along with the subsequent bone fragility can result in an increased risk of fractures. Osteoporosis literally means “porous bone.”
How can you know if you have osteoporosis? Alas, you can’t feel your bone porosity nor are there symptoms you can notice. Frequently, it is first diagnosed after a woman suffers a “fragility fracture.” The other sign you may have osteoporosis is the loss of height, but remember that some loss of height is normal as we age.
The only sure way to find out if you are losing bone mass is to undergo a bone density test. This simple, painless, 15-minute X-ray can usually be done with your clothes on (as long as you are wearing no metal – even metal bra hooks) and will help you and your health care professional tell if your bone density is normal (yay), low (osteopenia), or porous (osteoporosis).
In addition to requesting a bone scan, be sure to discuss your osteoporosis risk with your doctor. Risk factors include the following:
Non-modifiable risk factors
- Menopause status
- Family history
- Low body weight
- History of fractures or significant height loss
Modifiable risk factors
- Excess alcohol consumption
- Sedentary lifestyle
- Excess salt, caffeine, sodas
- Not enough fruits and vegetables in diet
- Not enough vitamin D and calcium (dietary)
The Good News
Simple lifestyle changes can help you prevent bone loss disorders such as osteopenia and osteoporosis. You can start right now to maintain or regain bone health.
Exercise: Get Moving
Depending on your individual risk, be sure to consult your physician about the types of exercises best for you. Here are some general exercise recommendations.
Strength training may be done using weight machines, free weights, resistance bands or water exercises to slow bone loss and strengthen muscles in the upper spine and arms. Although it may be tempting to increase weight quickly, much of the strengthening may be done with very light weights. Start with 2-pound hand weights and slowly increase the repetitions for a better workout. Slowing the motions can also paradoxically increase the amount of toning and is much better than trying to lift heavier weights.
Any exercise that stretches and extends your upper back and improves posture helps to reduce harmful bone stress and maintain density. Osteoporosis can lead to painful, debilitating compression fractures in the spinal column.
Walking, dancing, low-impact aerobics, stair climbing, and gardening work directly on the bones in your lower spine, hips, and legs to slow or prevent loss of bone. As a bonus, they provide a boost to overall cardiovascular health. If you are just beginning to exercise, walking may be the most beneficial starting place.
Swimming and water aerobics are great for your cardiovascular health but do not provide the necessary weight-bearing to slow mineral loss from your bones. However, they are excellent options for those with severe osteoporosis or recovering from a fracture.
Stability and Balance Exercises
These are simple exercises that help your muscles work together to increase your stability, thus preventing falls that can lead to injury. Standing on one leg, gentle tai chi movements or slow dance routines help improve stability.
Joint and muscle movement through our full range of motion helps us to maintain balance as well as prevent muscle injuries. It’s always best to stretch after muscles are warm, such as after your exercise routine. Be sure to perform movements slowly without bouncing. Avoid stretches that twist or flex your spine.
Exercises to Avoid
If you have been diagnosed with osteoporosis, avoid high impact activities such as jumping, running, or jogging as these can lead to injury. Rapid, jerky movements are not recommended. Slow, controlled movements have maximum benefit with minimal risk.
Twisting, bending exercises should also be avoided if you have osteoporosis. Toe touches, situps, and sports that require strong twisting moves such as golf, tennis, or bowling are not recommended as they increase the risk of compression fractures in the spine.
Check with your physician or physical therapist to see what exercises are right for you.
Vitamin D is important to bone health. It is readily available in fortified milk, egg yolks, saltwater fish, and supplements. Natural sunlight turns precursors in our skin into vitamin D. Good news: sunscreen does not impair your skin’s ability to synthesize vitamin D, so don’t expose your skin to direct sunlight without it.
Calcium is critical to bone health. Dairy products are high in calcium, but calcium is available in a number of other food sources, such as kale, beans, soybeans, broccoli, figs, sardines, shrimp, and salmon. Ensure that you get enough dietary calcium by eating these foods regularly.
A recent study found that taking supplemental calcium did not help with osteoporosis at all. Studies have also indicated that there may be cardiovascular health risks associated with taking calcium supplements. Talk with your doctor about what regimen is best for you.
Decrease Salt Intake
According to studies, postmenopausal women ingesting a high-salt diet lose more bone minerals than those who restrict salt. Table salt has been associated with calcium loss, leading to bone weakness over time. Avoid processed foods that are almost always high in salt and take the saltshaker off the table. Use herbs and spices to flavor your meals.
Fruit and Veggies
A diet high in fresh fruits and vegetables has been associated with healthier bones. At least one study showed that daily prune (aka dried plum) consumption showed benefit in reversing bone loss in postmenopausal women.
Simple Dietary Strategy
A diet low in salt and high in whole grains, fruits, and vegetables while avoiding processed foods is the best bet for preventing and treating osteoporosis. Limit caffeine and sodas, which can actually leach calcium out of the bones.
Medications for osteoporosis
The most common medications prescribed for osteoporosis are bisphosphonates. These act by slowing bone breakdown, helping to regain the balance between breakdown and rebuilding.
Teriparatide is an injectable used to treat those with very low bone density or those who’ve had osteoporotic fractures. This drug has the ability to rebuild bone and potentially reverse some of the effects of osteoporosis.
There is controversy about how long it is safe to use these drugs as two relatively rare but serious complications (erosion of the jaw bone and leg fractures) have been associated with long-term use so discuss the appropriateness of this treatment and its duration with your physician.
Estrogen, with or without progesterone, is approved for the prevention of osteoporosis and is as effective for prevention as the drugs listed above. Hormone therapies vary in their associated risks. Estrogen-only therapy has fewer risks and greater benefits but is usually only prescribed for women without a uterus. Undertake a risk-benefit analysis with a trusted health care professional to determine if some form of hormone therapy is right for you.
It’s never too soon (or too late) to begin a bone health regimen. Take care of your foundation by getting a baseline bone density test, eating a healthy diet, and engaging in low-impact movement and exercises. And don’t forget, there are effective and safe drugs and hormone therapies available.
Osteoporosis: Choosing the right form of exercise. Mayo Clinic. Retrieved January 12, 2016. http://www.mayoclinic.org/diseases-conditions/osteoporosis/in-depth/osteoporosis/art-20044989?pg=
Types of Osteoporosis Medications. National Osteoporosis Foundation. Retrieved January 13, 2016. http://nof.org/articles/22
Research: Calcium intake and risk of fracture: systematic review. BMJ Medical Journal. Retrieved January 12, 2016. http://www.bmj.com/content/351/bmj.h4580
Living With Osteoporosis: Osteoporosis Diet Dangers: Foods to Avoid. Web MD. Retrieved January 12, 2016. http://www.webmd.com/osteoporosis/living-with-osteoporosis-7/diet-dangers
Science News: Calcium supplements linked to significantly increased heart attack risk, study suggests. Science Daily. Retrieved January 13, 2016. http://www.sciencedaily.com/releases/2012/05/120523200752.htm
A Guide to Calcium-Rich Foods. National Osteoporosis Foundation. Retrieved January 12, 2016. http://nof.org/articles/886
Osteoporosis Special. Climacteric 2015; 18 (Suppl.2):1-62.
Reviewed January 18, 2016
By Philip Sarrel, M.D. and Lorna Sarrel, M.S.