Bones after the menopause: osteoporosis, risk factors and prevention
According to the NHS, oestrogen is key to healthy bones, and after the menopause its levels fall, which can lead to rapid loss of bone density and osteoporosis – a condition in which bones become fragile and break easily. The risk is higher with an early menopause (before 45), a family history, a low body weight, smoking and heavy drinking. For prevention, the NHS recommends weight-bearing and resistance exercise, 700 mg of calcium a day, 10 micrograms of vitamin D and stopping smoking.
- According to the NHS, bones are at their strongest until the late 20s, and from around the age of 35 a gradual loss of bone mass begins.
- The fall in oestrogen after the menopause can cause a rapid drop in bone density; the risk is even higher if the menopause happens before 45.
- Osteoporosis does not usually hurt – the first sign is often a broken bone, most often the wrist, hip or a vertebra.
- The NHS recommends 700 mg of calcium a day for adults, ideally from food, and 10 micrograms of vitamin D a day.
- Weight-bearing exercise (walking, running, dancing) and resistance exercise (weights, press-ups) are especially good for bone density.
Why do bones thin after the menopause?
According to the NHS, bones are at their densest and strongest in early adulthood – until the late 20s. From around the age of 35 everyone begins to gradually lose bone mass, but in some people this happens much faster and increases the risk of fractures.
Women are at greater risk than men because the hormonal changes of the menopause directly affect bone density. The NHS states that oestrogen is essential for healthy bones: after the menopause its levels fall, which can cause a rapid drop in bone density. The end result can be osteoporosis – a condition in which bones become fragile and break much more easily. The earlier stage, where density is below average for your age but not that low, is called osteopenia and does not always progress to osteoporosis.
How do you know you have osteoporosis if it does not hurt?
According to the NHS, osteoporosis develops slowly, over years, and does not usually cause pain until a bone breaks. Often the fracture is the first sign. The most common sites are the wrist, the hip and the vertebrae, but the arm or the pelvis can also be affected. Sometimes even a cough or a sneeze can break a rib or partially collapse a vertebra. Broken vertebrae are a common cause of long-term pain, and in some older people they lead to a stooped, forward-leaning posture.
The diagnosis is made with a DEXA scan – a quick and painless test of bone density that takes 10 to 20 minutes. The result is a T-score: above -1 is normal, between -1 and -2.5 is osteopenia, below -2.5 – osteoporosis. Your doctor can also assess your future risk of fracture with online tools such as FRAX or Q-Fracture.
What are the risk factors for osteoporosis in women?
According to the NHS, the risk for women is even higher with:
- an early menopause – before the age of 45
- a hysterectomy before the age of 45, especially if the ovaries were also removed
- absent periods for more than 6 months because of excessive exercise or strict dieting
Other risk factors the NHS lists for everyone:
- a family history of osteoporosis, especially a parent with a broken hip
- a body mass index (BMI) of 19 or lower
- long-term use of high-dose steroid tablets (more than 3 months)
- eating disorders such as anorexia or bulimia
- heavy drinking and smoking
- rheumatoid arthritis, an overactive thyroid or parathyroid gland
- conditions with impaired absorption such as coeliac disease and Crohn's disease
- some breast cancer medicines that affect hormone levels
- long periods of inactivity, such as prolonged bed rest
What exercise strengthens the bones?
The NHS recommends that adults aged 19 to 64 do at least 2 hours and 30 minutes of moderate-intensity aerobic activity a week (for example cycling or brisk walking) plus muscle-strengthening exercises on 2 or more days a week, covering all the major muscle groups. Two types are especially good for bone density:
- Weight-bearing exercise – your legs carry the weight of your body: running, skipping, dancing, aerobics. Over the age of 60, brisk walking, group classes and tennis are suitable. Swimming and cycling do not count as weight-bearing. Wear suitable shoes.
- Resistance exercise – the muscles pull on the bones and strengthen them: press-ups, weightlifting, gym machines. If you are not sure how to use them, ask an instructor.
If you already have a diagnosis of osteoporosis, the NHS advises talking to a doctor before starting a new programme.
How much calcium and vitamin D do you need?
According to the NHS, adults need 700 mg of calcium a day, ideally from food: leafy green vegetables, dried fruit, tofu and dairy products such as milk, cheese and yoghurt.
Vitamin D helps the body absorb calcium. All adults should get 10 micrograms a day. Sources are oily fish (salmon, sardines, herring, mackerel), red meat, liver, egg yolk and fortified foods. From late March to late September the sun stimulates vitamin D production, and a short time outdoors every day is enough; in autumn and winter it is too weak, so vitamin D has to come from food. Because it is hard to get enough from food alone, the NHS suggests considering a daily supplement of 10 micrograms.
The NHS also advises stopping smoking – smoking is linked to a higher risk of osteoporosis – and not exceeding 14 units of alcohol a week, with no binge drinking. Hormone replacement therapy (HRT), according to the NHS, also reduces the risk of osteoporosis, especially if your periods stopped before 45.
When should you see a doctor?
According to the NHS, it is a good idea to talk to a doctor if:
- your menopause happened before the age of 45 or your ovaries have been removed – then the risk is higher and HRT may be especially important for your bones
- you have a parent with a broken hip or another family history of osteoporosis
- you have been taking high-dose steroid tablets for more than 3 months, or anti-oestrogen medicines after breast cancer
- you have broken a bone after a minor fall or knock – this may be the first sign of osteoporosis
- you have a diagnosis of osteoporosis and want to start a new exercise programme
- you have osteopenia or osteoporosis and are worried about living with a long-term condition
Your doctor can assess your risk of fracture, refer you for a DEXA scan and, if needed, suggest medicines to strengthen your bones.
Frequently asked questions
Is swimming good for the bones?
Swimming is good for the heart and muscles, but according to the NHS it is not a weight-bearing exercise and does not count towards strengthening bone density. For your bones, combine it with walking, dancing or weights.
Does osteopenia mean I will develop osteoporosis?
Not necessarily. According to the NHS, osteopenia does not always progress to osteoporosis, but depending on your risk of fracture, your doctor may suggest medicines for it too.
Can HRT protect my bones?
According to the NHS, hormone replacement therapy helps to prevent bone thinning by raising oestrogen levels, and is especially important if your periods stop before the age of 45.
Sources
- NHS – Osteoporosis – Causes – last reviewed by the NHS: 13 October 2022
- NHS – Osteoporosis – Prevention – last reviewed by the NHS: 13 October 2022
- NHS – Osteoporosis – last reviewed by the NHS: 13 October 2022
Informational article retold in our own words from the sources listed. It does not replace a consultation with a doctor; in an emergency call 112. If you spot an inaccuracy, write to [email protected].