You know about the hot flashes, the vaginal dryness and the possibility of weight gain. But there’s another symptom of menopause to add to the list: bone loss.
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Bone loss happens when your bones deteriorate faster than they can grow and strengthen themselves — and as much as 20% of bone loss occurs within your first five years of menopause.
But what’s the big deal about bone loss?
It significantly raises your risk of bone fractures and can lead to osteopenia (low bone mineral density) and osteoporosis (weak bones). “Adults should not break bones when they fall from a standing position,” says women’s health specialist Holly L. Thacker, MD, FACP. “That is not a standard part of aging.”
Bone fractures can lead to a host of other health problems, too, so taking care of your bones is a key aspect of caring for your health in menopause. Dr. Thacker discusses what you need to know about menopause, bone loss, osteoporosis and more.
Does menopause lead to osteoporosis?
Your bones are living, growing tissues that constantly remodel themselves, and when you’re young, they rebuild quickly. Starting in your 30s, though, some amount of bone loss is natural. Your bones can’t rebuild themselves as fast as they used to, which causes a loss of bone mass.
That’s thanks to estrogen — or, actually, a lack thereof. Estrogen regulates your menstrual cycle and protects you from bone loss. But when you enter menopause, your body slows its estrogen production, leading to bone loss.
“When you don’t have enough estrogen, the bones break down much faster than they build up, and consequently, there’s a net loss,” Dr. Thacker explains.
Is early menopause a risk factor for osteoporosis?
Menopause triggers bone loss, period. So, no matter when it happens to you, you’re at risk when it does. “Throughout menopause, women should be tested for osteoporosis,” Dr. Thacker advises.
But typical menopause happens between age 45 and 55, so if you enter menopause before then, you’re also at risk for bone loss at an earlier age than is standard. That includes:
- Premature menopause (before age 40).
- Early menopause (before age 45).
- Primary ovarian insufficiency (POI), formerly called “primary ovarian failure.”
- Medical menopause, whether surgically induced or as a result of medical treatment, like chemotherapy.
How do you keep your bones healthy during menopause?
As soon as menopause makes its presence known, it’s time to talk to your doctor.
“It’s imperative to discuss and institute a bone loss prevention plan with your doctor when the first signs of menopause appear,” Dr. Thacker says. “It’s a great time to get a baseline bone density test and to go over your family history, lifestyle and medications, and what you can do to be strong and healthy.”
She explains some of the options for ensuring healthy bones during this time of your life.
1. Healthy lifestyle
It’s probably no surprise to learn that the same things doctors recommend for living an overall healthy life also help keep your bones healthy. This includes:
- Exercising regularly, including doing weight-bearing exercises.
- Eating healthfully and getting enough calcium and vitamin D.
- Avoiding tobacco and only drinking alcohol in moderation.
But that may not be enough to ward off bone loss.
“If you’re rapidly losing bone, all the exercise and milk and vitamin D in the world will not stop that,” she says. “Many women, especially those who have broken bones or who have a lot of risk factors, need prescription therapy. And we have many different safe, effective options to prevent bone loss, to build bone and to reduce your likelihood of broken bones.”
2. Hormone replacement therapy
Hormone replacement therapy (HT) is the gold standard in treating menopause, including bone loss. Why? Because it targets all of your symptoms. HT is typically the first and best course of action because it helps prevents bone loss and tackles some of the uncomfortable menopause symptoms, like hot flashes and vaginal dryness.
“If you’re experiencing symptoms of menopause, hormone therapy can improve your bone health while also addressing your symptoms,” Dr. Thacker notes. “It’s all about finding the right dose and the right route for each woman.”
There are different courses of HT for menopause, and what’s right for you will depend on your unique medical situation — for example, whether you’re in premature or early menopause, no longer have a uterus or are already in postmenopause.
There’s no time limit to how long you can be on HT, though it only helps your bones while you’re taking it. And 5% to 15% of women still lose bone density on HT, so it’s important that you continue to be monitored by your doctor.
If for whatever reason, you can’t or don’t want to be on HT, or if you’re on HT but still losing bones, your doctor may prescribe bisphosphonates. These medications are designed to slow bone loss.
They can also help prevent bone loss if you’re on glucocorticoids (steroid hormones that treat inflammation, autoimmune diseases and cancer). “Hormone therapy alone won’t protect you against glucocorticoid-induced osteoporosis, so bisphosphonates offer bone loss preventive therapy,” Dr. Thacker says.
4. Injectable medications
If you have severe osteoporosis, your doctor may consider anabolic agents, which build bone. There are currently three approved options on the market, and your doctor will determine which is right for you.
Managing osteoporosis after menopause
You might think you’re not at risk of bone loss because you feel fine. No joint pain, no broken bones, so problems, right? Not quite.
“There are no symptoms of osteoporosis until you break a bone,” Dr. Thacker warns. “That’s why you really have to be vigilant, and it’s why your doctor will want to know your family history, bone density and hormone levels.”
In other words, make no bones about it: If you’re going through menopause or starting to experience symptoms, it’s time to talk to your doctor about preventing osteopenia and osteoporosis. Your bones will thank you for it!