Even before menopause happens, marked by the end of menstrual periods, bone changes are already silently happening in a woman’s skeleton, making her more at risk for fractures in later life.
“In a typical premenopausal woman, estrogen supports bone building and inhibits bone breakdown. It enables the body to be more effective at mineralizing bone,” said Leah Prestbo, MD, Avera family medicine physician with a special interest in bone health.
“When the supportive effect of estrogen begins to decrease, we see less bone building activity and more bone breakdown, resulting in that decline of bone density we see at menopause,” Prestbo said.
These changes can begin to happen up to three years before a woman’s last period, during a season known as perimenopause.
“Even before a woman’s final period, she’s losing 2% of her bone mineral density per year,” said Annie Siewert, MD, Avera OB/GYN specialist.
Is There a Screening for Bone Loss?
DXA scan, a special imaging tool that measures bone density, is recommended for woman at age 65. But by age 65, bone loss has already started, as the average age of menopause is 51.
So for women and their medical providers, awareness is possibly the most important thing. While the fracture risk is lower for women as they live through their 50s and 60s, risk increases as they reach their 70s and 80s, if bone loss is not addressed through preventive measures. A free online too, FRAX®, calculates risk of osteoporosis and fracture risk.
In addition to age, risk factors include smoking, parental history of hip fractures, rheumatoid arthritis, and alcohol use that’s considered greater than moderate.
How Do You Prevent Bone Loss?
The thought of bone loss might nudge you to reach for that extra glass of milk or cup of yogurt. It’s true that getting adequate calcium is important throughout your lifetime. Food sources are best as opposed to calcium supplements. Adequate vitamin D helps your body absorb calcium.
But overdoing it on calcium intake won’t suddenly build bone at midlife. In addition, too much calcium can lead to unwanted problems like cardiovascular disease and kidney stones.
Another key preventive solution during perimenopause and menopause is estrogen. While oral estrogen pills are considered safe, transdermal estrogen that’s delivered via a patch, cream or gel is considered the safest.
“Estrogen is a great solution because it helps prevent bone loss, today and in the future, and also addresses other symptoms and discomforts of menopause,” Siewert said.
Exercise is also a preventive strategy. “At midlife, the right combination of exercise can help you maintain the bone strength you have,” Prestbo said.
She recommends 30-40 minutes of exercise, several times a week, with a routine that includes aerobic, weight bearing/resistance and balance exercise. “Exercise is a powerful thing that works differently in the skeleton at different ages,” Prestbo said.
How Do You Treat Bone Loss?
An indicator like high calcium levels in the blood and/or a DXA scan score of -2.5 or lower may be reasons for a referral to Avera’s bone health clinic. High calcium in the blood can indicate that calcium is being released from the bones into the bloodstream, rather than stored.
“If someone is diagnosed with osteoporosis, which is a DXA scan of -2.5 or below, there’s a range of treatment options, depending on the severity and risk of future fractures,” Prestbo said.
Common bone density medications work to strengthen bones and reduce fracture risks. These include bisphosphonates, like Fosamax, or zoledronic acid, like Reclast and Zometa. These can be administered alongside anabolic agents that build new bone.
“Taking care of your bones is just as important as any vital organ that you have. In addition to serious fractures, osteoporosis can cause crippling pain, loss of mobility and a stooped posture in later life. That’s what we want to prevent as women reach perimenopause and menopause,” Prestbo said.
Talk to your primary care provider about addressing the symptoms of menopause as well as bone loss.
This is one in a series about women’s health before and after menopause. Topics include hormone therapy, exercise, nutrition, weight loss, mood, sleep, bone loss and more.
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