Menopause & osteoporosis: Is there a link?

This article was reviewed by Julia Switzer, MD, FACOG.

Key takeaways:

• Women are more likely to have osteoporosis than men, and it often starts around menopausal age.

• Menopause also lowers estrogen levels, which can contribute to brittle, weakened bones.

• Your healthcare provider can assess your risk factors and recommend medication or lifestyle changes to manage menopause symptoms and prevent or slow bone density loss.

Menopause is a time of change. As it approaches, your period becomes more irregular, you may experience symptoms like hot flashes and night sweats, and you might gain weight more easily.

One thing you may not think about amid this whirlwind of changes is bone mineral density. Yes, menopause bone loss is a thing — women experiencing menopause are at a higher risk of osteoporosis.

But what exactly is osteoporosis? And how is it connected to menopause? Keep reading for answers to these questions and more.

Osteoporosis is a condition where bones weaken and have a higher risk of fractures. It’s estimated that 10.2 million people in the United States aged 50 or over have osteoporosis, and 43.3 million have low bone mass (called osteopenia).

Bones are actually made of living, active tissue. As you go about daily activities, cells called osteoclasts break down old bone tissue while osteoblast cells work on building new bone.

When this bone turnover isn’t balanced, more bone breaks down than is replaced. Over time, the insides of bones become more porous, while the outer shell becomes thinner and more brittle.

Where and When Osteoporosis Happens

These changes lower bone strength and increase the risk of broken bones. The bones most commonly affected by osteoporosis are those in the hips, spine, and wrists.

Women are more likely to develop osteoporosis. The condition impacts one in five women over age 50 (around menopausal age), compared to one in 20 men.

The effects of menopause can boost your risk of osteoporosis. Why does menopause cause osteoporosis? Let’s dive into the details.

The link here is actually between estrogen and osteoporosis. During the menopausal transition, called perimenopause, the ovaries start making less estrogen and progesterone.

This drop in hormone levels is what leads to many of the menopause symptoms you may be familiar with, such as:

• Hot flashes

• Night sweats

• Privates dryness

• Mood changes

It’s also what contributes to bone loss.

Low Estrogen and Bone Density Loss

Estrogen promotes osteoblast activity. So, when estrogen levels become low, less new bone is made. Meanwhile, osteoclasts are still driving the resorption of old bone. (Resorption is when bone tissue breaks down and is absorbed by the body.)

As time passes, more bone tissue is being lost than made, leading to lower bone density and an increased risk of osteoporosis.

Researchers have found that bone loss occurs most rapidly over a three-year period. This includes late perimenopause and early postmenopause. Basically, you’re losing bone more quickly the year before your final menstrual period and the two years after it. After this window passes, bone loss slows.

It’s also important to point out that women who experience early menopause or premature menopause (menopause between the ages of 40 and 45) also experience bone loss and are at a higher risk of osteoporosis.

One study found that being a younger age at the time of your final menstrual period (premature menopause) is linked with lower postmenopausal bone density and is also associated with a higher risk of fractures.

Other Risk Factors for Osteoporosis

By the way, in addition to low estrogen levels and older age, there are also other factors that can boost your risk of developing osteoporosis. These include:

• A family history of osteoporosis

• Previous broken bones

• A diet low in calcium or vitamin D

• Smoking

• Excess alcohol consumption

• Physical inactivity (sedentary lifestyle)

• Use of certain medications like corticosteroids, epilepsy medications, and cancer medications

• Medical conditions like hyperthyroidism, diabetes, rheumatoid arthritis, and HIV/AIDS

• Being underweight

As you can see, some of these are more in your control, like how much physical activity you get and whether you smoke or drink regularly. But other risk factors are based on genetics and medical conditions. Consult a healthcare professional to assess your risk for osteoporosis.

Knowing your menopause bone density and your future risk of fractures can help you take steps to improve your bone health. The U.S. Preventative Services Task Force recommends osteoporosis screening for:

• All women aged 65 and older

• Women under age 65 in the postmenopausal stage who have one or more risk factors for osteoporosis

Screening typically involves testing bone mineral density (BMD). The test typically used is called a DEXA (dual energy X-ray absorptiometry) scan.

A DEXA scan is a special type of X-ray that measures the levels of calcium and other minerals in bones. It typically looks at the hip and spine since these are commonly affected by osteoporosis.

The scan itself can be completed in around five minutes and involves exposure to very low levels of radiation. Afterward, you’ll get your results in what’s known as a T-score.

Here’s a breakdown of what your T-score means:

• -1 or above. You have healthy bones.

• -1 to -2.5. You have osteopenia, a condition where bone density is low, but not low enough to be considered osteoporosis.

• -2.5 or lower. You have osteoporosis.

A healthcare provider may also use something called a FRAX (fracture risk assessment tool) to estimate your risk of experiencing a fracture over the next 10 years. Simply put, a FRAX score considers several risk factors to determine future fracture risk.

Generally speaking, a 10-year fracture probability of over 20 percent is often used as the cutoff for recommending treatment.

The high risk of fractures that comes with osteoporosis is no joke. Osteoporosis-related fractures are associated with reductions in health-related quality of life and the ability to do daily activities.

Hip fractures are especially concerning. It’s estimated that only 33 percent of older women who experience a hip fracture completely gain back their independence.

The great news here is that there are absolutely things you can do to protect your bones during and after menopause. Let’s go over these now.

Medications to Protect Bones During Menopause

A variety of medications may be prescribed to help make new bone tissue, prevent additional bone loss, and reduce the risk of fractures. These include:

• Bisphosphonates. Bisphosphonates are the most commonly prescribed type of medication for osteoporosis. They help prevent further bone loss.

• Denosumab. Denosumab is an injectable medication that can help boost bone strength and prevent bone loss.

• Teriparatide. Teriparatide is another injectable medication and a form of human parathyroid hormone (PTH). It works by increasing the production of new bone tissue.

• Calcitonin. Calcitonin is a form of a hormone made by the thyroid gland. It helps manage calcium levels in the body and can slow bone loss.

• Selective estrogen receptor modulators (SERMs). SERMs like raloxifene bind to estrogen receptors in the body and help reduce bone loss.

How long you take a medication for osteoporosis depends on the specific type of medication you’re prescribed.

Menopausal Hormone Therapy to Protect Bones

One way to help prevent postmenopausal osteoporosis is with menopausal hormone therapy (MHT). Also called hormone replacement therapy (HRT), this treatment works to replace missing estrogen and progesterone.

Beyond reducing the frequency and intensity of menopause symptoms, MHT helps slow bone loss associated with menopause. This can reduce the risk of osteoporosis and osteoporosis-related fractures.

You should discuss the benefits and risks of MHT with a healthcare provider before starting it. That’s because, depending on the type of MHT used, the treatment can lead to a small increased risk of breast cancer, endometrial cancer, blood clots, stroke, or heart attack.

A healthcare provider may recommend MHT if you’re:

• In the postmenopausal stage and under age 60

• Less than ten years postmenopause and are having vasomotor symptoms like hot flashes and night sweats

The Menopause Society notes that most women take MHT for four to five years before stopping.

Bone loss will pick up right where it left off when you stop taking MHT. That means you’ll need to use additional measures to protect your bones.

Lifestyle Changes to Protect Bones

There are several simple lifestyle changes you can make to help support bone health. These include:

• Getting enough vitamin D and calcium. Both nutrients are critical for maintaining bone health. Talk to your healthcare provider about foods rich in vitamin D and calcium to include in your diet, and ask if they recommend taking a vitamin D supplement, calcium, or both.

• Start moving. Exercise is vital for bone strength. Try to focus on weight-bearing exercises, like walking, weight lifting, climbing stairs, and dancing.

• Quit smoking. Smoking increases the risk of osteoporosis (and a whole lot of other health conditions). If you do smoke, talk to your healthcare provider about ways to quit.

• Limit alcohol consumption. Excess alcohol consumption is linked to an increased risk of osteoporosis, so aim to drink in moderation or not at all. For reference, moderate drinking for women is one drink or less each day.

Let’s review some key points about menopause and osteoporosis:

• Osteoporosis is a condition where bones become porous and brittle, increasing the risk of fractures. It’s more common in women.

• During and after menopause, women are at a higher risk of osteoporosis due to lower estrogen levels. Estrogen is vital for stimulating the cells that make new bone tissue, so when estrogen levels are low, bone tissue breaks down faster than new tissue can be made.

• A healthcare provider can use various tests and tools to check your bone density. Screening is typically recommended at age 65 or older but may be done earlier if you have risk factors for osteoporosis.

• Medications, including menopausal hormone therapy, can be used to help slow bone loss associated with menopause.

• Lifestyle changes — like getting enough vitamin D and calcium, doing weight-bearing exercises, and quitting smoking — can help boost bone health.

Keeping your bones healthy and strong is just one aspect of women’s health during menopause. Still, it’s an important step to take to reduce your risk of osteoporosis and broken bones.

If you have concerns about osteoporosis as you approach menopause, make an appointment with your healthcare provider to discuss them. Your primary care provider or a gynecology specialist is a great place to start.

A healthcare provider can answer your questions about menopause and osteoporosis. They can also recommend medications and lifestyle changes to help keep your bones as healthy as possible during and after menopause.

Related:

• Progesterone pills vs. creams: What is best for me? Do they cause weight gain?
• From acne to aging: Dermatologist-recommended skin care tips

Like MediaFeed’s content? Be sure to follow us. 

This article originally appeared on Forhers.com and was syndicated by MediaFeed.org