Menopause is the period in a woman’s life (typically between the ages of 45 and 50) when menstruation naturally ceases. It can potentially increase the risk of developing osteoporosis, a medical condition in which the bones become brittle and fragile and lose their density from the loss of bone tissue. This typically occurs due to hormonal changes and/or due to deficiency of calcium or vitamin D.

The risk of fractures due to even mild trauma is very high and the fractures usually develop in the bones of the spine, hip, and wrist.

Postmenopausal women are at a high risk of primary osteoporosis because osteoporosis is closely related to estrogen deficiency.

Increased bone loss during and post-menopause occurs due to the drop in levels of the hormone, estrogen. During the first five years after menopause, women lose about 10 percent of bone tissue.

Osteoporosis is a silent disease, and you may not experience any symptoms during the early stages. Symptoms start setting in during the third and fourth stages. Your doctor will initially suspect it after you suffer a fracture very easily even with mild trauma, which otherwise you would not.

Though treatments for managing osteoporosis are available, this condition cannot be reversed. Drugs given for osteoporosis help to rebuild bone tissue and slow down bone loss. Besides medication, a bone-friendly nutrient-dense diet, and weight-bearing exercises also contribute positively to managing osteoporosis

Both the osteoporosis diet and the prescribed exercises can help prevent osteoporosis later in life if you start adopting them in your lifestyle when you are still young.

Symptoms of post-menopause and osteoporosis

Often, a person with osteoporosis will not know about his condition till he suffers a fracture or undergoes a bone density test.

Fractures associated with osteoporosis most commonly occur in the hip, vertebrae, or wrist. However, fractures can also occur in other bones and such fractures can occur even with minor activities such as sneezing or coughing.

In addition, other symptoms of menopause can include:

  • hot flashes
  • vaginal dryness
  • changes in periods
  • headaches
  • reduced sex drive
  • mood changes
  • anxiety
  • palpitations

How does menopause increase the risk of osteoporosis?

Peak bone mass is the maximum amount of bone mass a person has during his or her life. It typically is at its peak in the early 20s in females and late 20s in males. At this time, the bones have stopped growing and are at their strongest and thickest. However, bone mass is typically lower in females than in males.

The female hormone, estrogen plays a key role in bone metabolism in both men and women and is important in maintaining bone strength. It promotes the activity of osteoblasts, which are cells that produce bone.

The ovaries make most of the estrogen in the body during a woman’s reproductive years. During menopause and postmenopause, the woman’s menstrual cycle stops and the ovaries do not make estrogen.

Low estrogen levels usually lead to porous, weakened bones, a decline in bone mineral density, and osteoporosis. This is more probable especially if your peak bone mass before the onset of menopause is not optimum.

Studies reveal that about 50 percent of women above 60 years of age suffer from at least one fracture due to osteoporosis.

How to reduce the risk and prevent osteoporosis after menopause?

You can reduce your risk of developing osteoporosis during and after menopause by following certain lifestyle and dietary recommendations. As mentioned above, it is best if you start adopting these recommendations early on in life to maximize benefits. They include:

  • Stick to the bone-friendly osteoporosis diet. It ensures 1,300 mg of dietary calcium intake every day. It includes three to four servings of dairy food, calcium-fortified soy or almond drinks, firm tofu, almonds, brazil nuts, dark green leafy vegetables, and fish that have edible bones like sardines and salmon. Of all these foods, fish and dairy are best to provide higher levels of calcium.
  • Vitamin D promotes calcium absorption in the intestines from the food you eat.  You can get enough vitamin D from adequate exposure to sunlight.  It is found in the following foods
    • Fatty fish, like salmon, tuna, and mackerel
    • Beef liver, cheese, and egg yolks
    • Foods fortified with vitamin D, such as milk, orange juice, and cereal
  • Physical activity reduces the risk of postmenopausal osteoporosis. Exercise regularly with appropriate types of exercises. There are some exercises that help in osteoporosis while some are contraindicated. There are two types of exercises that help build and maintain bone density: weight-bearing and muscle-strengthening exercises.
  • Avoid excessive alcohol intake. Stick to safe drinking limits
    Avoid smoking. Smoking cigarettes increases the risk of developing osteoporosis during and after menopause.
  • Avoid excessive caffeine intake.

Treatment of osteoporosis in postmenopausal women

Osteoporosis risk increases after menopause because levels of estrogen drop after menopause. This is because healthy estrogen preserves bone density and plays a vital role in the growth of bone as well as in the regulation of bone turnover during the adult years.

Early menopause increases the risk of osteoporosis. If you start experiencing symptoms of early menopause, you should have a bone density test so that osteopenia or osteoporosis will be diagnosed early and appropriate therapy initiated.

Once your diagnosis of osteoporosis is confirmed, your doctor will evaluate you for the best line of treatment from the options available.

Most doctors until recently recommended long-term hormone replacement therapy (HRT) to treat postmenopausal women to prevent bone loss. However, this did more harm than good. Results showed that estrogen plus progestin increased the risk of breast cancer and cardiovascular problems.

Treatment of postmenopausal osteoporosis aims to:

  • slow or prevent further progression of osteoporosis
  • maintain strong bone mineral density
  • prevent fractures
  • reduce pain
  • facilitate daily life activities of the person

Drugs that can help treat osteoporosis include:

  • Bisphosphonates. These antiresorptive drugs are the first line of treatment and the most preferred ones that slow bone loss and reduce the risk of fracture.
  • Estrogen agonists or antagonists. These are referred to as selective estrogen receptor modulators (SERMS). These drugs can reduce the risk of spine fractures in postmenopausal women. Raloxifene (Evista) is an example.
  • Calcitonin (Calcimar, Miacalcin). Calcitonin-salmon (Fortical and Miacalcin) is a synthetic hormone. In patients with osteoporosis, calcitonin produces a moderate increase in bone mass by slowing down the rate of bone resorption. This helps to prevent spinal fractures in postmenopausal women.
  • Parathyroid hormone, such as teriparatide (Forteo). This hormone stimulates bone formation and is approved by the U.S. Food and Drug Administration (FDA)  for treating people with a high risk of fracture.
  • Monoclonal antibodies (denosumab, romosozumab). These are immune therapies that are prescribed for some women with osteoporosis after menopause. They promote the formation of new bone and also slow down bone resorption.
  • Vitamin D and calcium supplements. Calcium is essential to maintain bone density and to ensure proper absorption of calcium, you need to have enough vitamin D. It usually becomes necessary to have supplements of calcium and vitamin D after menopause. You need to have 1300 mg of calcium every day through your diet. Adequate sunlight exposure every day can also boost vitamin D production in your body and contribute to bone health. Your doctor may prescribe calcium and vitamin D supplements if you are not getting enough of these micronutrients through your diet.