Hot flushes and weight gain tend to get a lot of airtime when it comes to menopausal symptoms, and fair enough but what about bone density changes?
There is no denying that hot flushes are annoying. However they don’t quite carry the same impact to long-term quality of life and even mortality risk that declining bone health does. Every single female is at increased risk of bone loss through menopause.
What makes bone loss a little more challenging is that there are essentially no symptoms and no pain, no warning signs that bone loss is occurring until a fracture occurs and by then osteoporosis could be well established.
Osteoporosis is a condition in which bone strength declines increasing the risk of fracture from non-traumatic injury such as simply falling over. It used to be considered a condition of aging but we now know this is not the case. It occurs due to an accumulation of factors that stretch back to childhood and its incidence and rate of progression can be impacted positively by nutrition and lifestyle choices.
Osteoporosis affects men and women, but like a lot of chronic health conditions the prevalence in women far outweighs that of men, so understanding the potential progression and how risk can be reduced is really important.
Bone strength is most significantly impacted in women during perimenopause and the transition into menopause due to the decline in estrogen. Estrogen has a powerful role to play in the maintenance of bone strength through its impact on bone cells but also muscle mass.
The hormonal transition through to menopause has been described as a time-limited window of opportunity to intervene to prevent rapid bone loss and stave off osteoporosis in later years. This time window is specifically the last year prior to the final menstrual cycle and 2 years after.
Interestingly, if we take this back to hot flushes for a minute, there is evidence that women who experience worse hot flush symptoms may be at higher risk of bone strength loss because these are also tied directly into changes in estrogen levels.
HOW TO KNOW HOW HEALTHY YOUR BONES ARE:
The gold standard to check bone strength is a bone mineral density scan, or DEXA scan. This is going to give the most detailed information on your bone health and can be a useful data point to monitor bone health over time.
If you are in the perimenopause transition and have a bone fracture, especially if it’s caused by an accident that really shouldn’t have led to a fracture it is worth getting a bone scan done.
BONE HEALTH RISK FACTORS:
Our bone strength is built up and reaches its peak at around 30 years of age, before starting to slowly decline.
Everything from nutritional status, sunshine exposure, physical activity to hormonal birth control use can have an impact on the foundation that we have to play with as we age.
A couple of common risk factors worth mentioning are:
- Use of antacids medication like omeprazole, especially over a long period of time. Research has shown this can impact bone strength, likely due to the impact on mineral absorption from reduced stomach acid levels.
- Vitamin D levels below 50 nmol/L have been associated with reduced bone density. Some studies suggest that even below 75 nmol/L is an issue. It is common in NZ and Australia to see levels lower than this even in summer.
- Limited physical activity, especially activity that involves external load bearing. Strength or resistance training as well as explosive movements in particular exert a positive stimulus on bone density.
- Obesity is also an interesting risk factor. For some time, extra body weight has been considered protective in that it exerts more pressure on bones stimulating cell turnover and strength. Newer research though suggests that the inflammatory factors of obesity, combined with higher levels of insulin are a negative when it comes to bone health
- A lifetime of yoyo dieting and under-eating. This is more common in women which is interesting considering womens higher risk with developing osteoporosis. Dieting and under-eating leads to low protein and mineral levels which reduces the building blocks to maintain bone.
INTERVENE IN THE TIME-LIMITED WINDOW:
The perimenopause years are a window of time that you can take action and significantly reduce the risk of bone density decline, osteoporosis and bone fractures later in life. Here are 3 top recommendations to get started.
Get your vitamin D levels checked:
One of vitamin D’s primary roles is to improve the absorption and utilization of calcium in the body. Low vitamin D levels are way too common and easily fixed with a regular supplement. Of note research suggests that daily or monthly oral supplementation of vitamin D is better for bone health than a yearly injection.
Eat adequate protein:
A lot of people are simply not eating enough protein, especially in the form of animal protein. These foods are good sources of the amino acids we need to build strong bones, but also bioavailable minerals like iron, magnesium and calcium.
Resistance training 2-3x per week:
Resistance training or strength exercise is the most important exercise for bone health. This is movements that involve moving and external load, more than just body weight. This puts extra weight stimulus on the bones which causes adaptation to improve strength. It also stimulates muscle growth which increases pull on bones, further strengthening them. The saying if you don’t use it you lose it is very true in this case.
What about calcium supplements:
Adequate calcium is critical for bone health, however the research on benefits of calcium supplements is confusing and inconclusive in most cases.
Ensuring adequate dietary calcium intake, alongside optimal vitamin D levels is the best thing you can do to support bone health. Lower dose supplements of around 500 mg per day may be beneficial for those who struggle to get enough from diet and should be taken with vitamin D
SUMMARY:
The hormone transition through to menopause is a time of accelerated bone loss, which can significantly impact risk of osteoporosis and bone fracture later in life. The challenge here is that this is a condition that could have been developing for years prior due to various diet and lifestyle factors and there are no symptoms to elude you to the fact.
Osteoporosis is an avoidable condition but it requires taking action early. A lot of the actions that make the biggest difference are habits that are built into the Body Reset Program such as regular resistance training, increased protein intake and blood marker checks to understand nutrition status. If you value the health of your bones and are keen to do more, take our quiz to see how we can help.
REFERENCES:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6226267
https://pubmed.ncbi.nlm.nih.gov/27224743
https://pubmed.ncbi.nlm.nih.gov/26623005