Whether you’re a woman in your 20s, 40s or 60s, if you don’t know about the link between the menopause and osteoporosis, read on. And men, if you have a female partner, sister, friend or mum, this is for you, too. Menopause is not talked about enough, and we shouldn’t shy away from it, even if it doesn’t directly affect you.
Hundreds of thousands of women suffer from debilitating menopause symptoms, including osteoporosis, which leads to more than just fractures. These fractures can actually lead to an increased risk of death. Fortunately, there are things that you can do to improve your bone health, and we explore these below with the help of a nutritional therapist and specialist in midlife and bone health.
Why is it important to be aware of osteoporosis and the menopause?
Last week, we marked Osteoporosis Awareness Day 2024, and it’s important to continue the conversation, especially as we are also acknowledging Menopause Awareness Month this October. These two health issues are closely related, yet many people are unaware of their connections.
So, why is that? Research shows that many women only begin learning about the symptoms of menopause when they start experiencing them. That can be a really confusing time. You’re usually around mid-forties, you might otherwise feel totally healthy, and then you start experiencing unusual symptoms like headaches, brain fog, and maybe urinary tract infections (UTIs). Sometimes it’s not even until your periods stop or you start getting hot flushes – which is probably the most well-known menopause symptom – that you start to link the signs with the cause.
For some women, the symptoms can be so unsettling that they worry they’re experiencing a serious illness, or they might feel discouraged from seeking medical advice, worried that their concerns won’t be taken seriously. Others might shy away from treatment options like hormone replacement therapy due to concerns about the potential breast cancer risks. But it’s vital to at least be aware of these symptoms, as well as the related risks, such as osteoporosis, so that you can prepare for them.
If you’re a woman in your twenties, thirties or forties, there are things you can do now to help improve your bone health so that you have less chance of experiencing osteoporosis later in life. But let’s talk about why it’s important to be aware of osteoporosis, as you might be thinking, “this isn’t something I have to deal with for another ten, twenty or thirty years. Why should I have to alter my lifestyle now?”
Well, according to the International Osteoporosis Foundation, one in three women over the age of 50 will suffer from fragility fractures, including hip fractures, which are the most severe. Shockingly, around 24% of women who experience a hip fracture die within one year, and 40% of those who survive lose the ability to walk independently. This is why we need to address these topics together, as they are deeply connected to a woman’s health during and after menopause.
Menopause and its links with osteoporosis
In the UK, the average age at which women enter perimenopause is around 45, although this can vary from person to person. Perimenopause is the transitional period leading up to menopause, and it can last anywhere from a few months to several years. During this time, women experience changes in hormone levels, particularly oestrogen, which can lead to various physical and emotional symptoms.
Menopause itself is defined as the point when a woman has not had a menstrual period for 12 consecutive months. The perimenopause phase can sometimes be confused with menopause, but menopause refers to the actual point when menstruation stops.
Despite how common these changes are, a startling number of women know very little about menopause. A recent survey from University College London revealed that nine in 10 women were never educated about the menopause and over 60% only started looking for information about it once they began experiencing menopausal symptoms.
If you aren’t educated on the perimenopause and menopause, this knowledge gap can make it more challenging to recognise when symptoms are part of the natural ageing process and when they could indicate something else, like osteoporosis.
What is osteoporosis?
Let’s take a closer look at osteoporosis, sometimes referred to as a “silent disease”. It causes the bones to become weak and more like to fracture or break. If you look at a cross section of bone affected by osteoporosis, it would look more porous than a healthy bone, because the bone is slowly losing density.
This condition progresses slowly, often without any pain or other symptoms, until a fracture occurs. Most commonly, women experience fractures in the hip, spine, or wrist, and by the time the first fracture happens, the disease is often quite advanced.
To understand more about why women with menopause are at a higher risk of osteoporosis, and what they can do to increase their bone health, we asked Kat Bright, a Nutritional Therapist at The Health Boost, specialising in midlife and bone health, to provide us with some expert advice and information.
Why are menopausal women more at risk of osteoporosis?
Kat says, “As we get a bit older, we experience a decline in oestrogen, one of our sex hormones. This can affect the activity of the osteocytes, which in turn affect the osteoblasts – the bone building cells – and the osteoclasts – the bone breaking down cells. This decline in oestrogen leads to a decrease in bone remodelling.
“However, another really big driver of osteoporosis is actually associated with ageing. We have an increase in the reactive oxygen species. This is an inflammatory process that influences these osteoclasts, which break down the osteoblasts and the osteoclasts. As we get older, if we have an inflammatory lifestyle or an inflammatory diet, this will mean a much higher inflammatory cascade in the body. This inflammatory cascade will then create a much greater bone turnover.
“As inflammatory lifestyle could include sleep deprivation, which we know is part of one of the menopausal symptoms. It could also include eating a lot of ultra-processed foods; inactivity and having a very sedentary lifestyle; overactivity; obesity; chronic stress; smoking; and regular exposure to pollutants or chemicals.
“All of these things will contribute to an inflammatory lifestyle. What we really want to do is try and follow an anti-inflammatory diet; try to reduce stress; get better sleep; avoid ultra-processed foods; avoid being overweight or underweight; make sure that we’re eating things like oily fish (like salmon, mackerel and sardines) at least three times a week; ensure we have a really good high fibre intake (around 30 grams per day, which will include lots of vegetables, fruit, beans and lentils). You also want to make sure you’re physically active without doing too much or too little, and to get outside in nature.”
Which supplements can help improve bone health?
“Many of the traditional medications for osteoporosis look at stopping the osteoclast activity – the breaking down effect. But what those medications don’t take into account is the inflammatory burden that is part of the picture of osteoporosis.
“bonebalance contains a bioactive collagen peptide that helps to form the bone matrix, which is the tissue that gives the bone both strength and flexibility. To improve your bone health, you need to take a collagen peptide that is the right molecular weight and shape to be absorbed into the bone tissue. Not all collagens will actually have this effect; a collagen for skin, for instance, won’t necessarily get into your bones. bonebalance helps to stimulate that collagen metabolism in your bones. It stimulates the bone building cells – the osteoblasts – and it reduces the bone breakdown cells – the osteoblasts. Therefore, it improves both the bone matrix and your bone mineral density.
“There are lots of studies that have been conducted on this particular collagen peptide, which is in bonebalance. The supplement is a really good insurance policy for all women over the age of 50. Quite often, osteoporosis is called a silent killer, because we don’t actually know we’ve got osteoporosis until perhaps we’ve broken a few bones, and then we’re referred for a DEXA scan to see what our bone health is like.
“By taking the bonebalance collagen, and adopting anti inflammatory diet, you’re ensuring that your bones are in good shape. I think it’s an essential part of our toolkit we’ve got, as midlife women, to keep our bones as healthy as possible.”
New treatment developments for osteoporosis
Not all menopausal women will get osteoporosis, but it’s important to know that there’s no cure for it yet. However, there is some good news when it comes to treatment options to manage the condition. Recently, the National Institute for Health and Care Excellence (NICE) recommended a new treatment for osteoporosis for postmenopausal women. This treatment is called romosozumab, which is a monoclonal antibody (a lab-produced antibody which can bind to specific targets or cells).
It works by both increasing bone formation and reducing bone breakdown, so it’s exactly what’s needed to help prevent the progression of osteoporosis. But it’s important to remember to apply all the recommended lifestyle changes alongside treatment, and consider taking supplements.
Bone density tests: How often should they be done?
We mentioned earlier that osteoporosis is known as a silent disease, so how do you keep abreast of your bone health? You don’t want to wait until you get a fracture, so it’s important to undergo tests to measure your bone density and gain an indication of your bone health.
These tests are called DEXA scans, where you lie on a table and a machine passes over you, scanning your bones with a low-dose x-ray. It’s completely painless, and not claustrophobic like an MRI.
How often should older women get DEXA scans? According to research, women aged 65 and older should have their first bone density scan. After that, if the results show a healthy bone density, they may not need another scan for up to 15 years. However, if the initial test shows low bone density or other risk factors for osteoporosis, it’s recommended that they get tested more frequently, typically every two to five years.
However, each case is different, and it’s always best to discuss your personal risk factors with your GP, especially if you have a family history of osteoporosis, have gone through early menopause, or have other underlying health conditions.
What to do next
Both osteoporosis and menopause are significant health issues that women need to be more informed about. Whether it’s understanding the changes your body goes through during perimenopause or recognising the risk factors for osteoporosis, awareness is key to taking control of your health.
If you’re experiencing symptoms related to menopause or are concerned about osteoporosis, please speak with your doctor, whether that’s your GP, a hormone specialist or a specialist in orthopaedics. There are treatments available, and positive lifestyle changes can also help reduce your risk, whatever age you are.
