From laugh lines and gray hairs to stiff joints, we all see and feel changes in our bodies as we get older. But one thing we all experience but can’t see is a change in bone density (or bone loss).
Changes in bone density are a natural part of aging. This is why taking steps to protect your bones – like getting enough calcium and regular physical activity – is so important. But some people experience more bone loss than others, which can put them at risk of osteoporosis.
Women who have gone through menopause can be especially high-risk for this condition, which is more specifically called postmenopausal osteoporosis. Why is this?
Below, we explain the relationship between menopause and osteoporosis, risk factors, how it’s treated, and what you can do to prevent postmenopausal osteoporosis and improve your bone health.
What is postmenopausal osteoporosis?
Postmenopausal osteoporosis is what it sounds like: It’s the development of osteoporosis after menopause.
Osteoporosis happens when a person’s bones begin to lose more mass (and at a faster pace) than what is normal for their age. And this bone loss leads to more brittle bones and a higher risk of fractures.
Postmenopausal osteoporosis is osteoporosis that’s related to the decrease in estrogen production that occurs during menopause. In women, estrogen helps to slow down bone loss. So as estrogen levels decrease, bone loss can accelerate. This means that after menopause, you may be more likely to experience bone loss that can lead to osteoporosis.
Are there risk factors for postmenopausal osteoporosis?
Besides being postmenopausal, the condition can be influenced by several other risk factors, including:
- Family history of osteoporosis
- Thin or small body frame
- Diet low in vitamin D and calcium
- Being underweight
- Sedentary lifestyle
- Tobacco use
- Early menopause, which can result in lower bone density later in life
- Regularly consuming more than two alcoholic drinks per day
- Long-term use of certain medications such as steroids or Depo-Provera
Postmenopausal osteoporosis symptoms
As we mentioned earlier, some bone loss as you age is normal. But even if more bone mass is being lost than normal, many people don’t notice any symptoms until a fracture happens. The most common fractures are hip, wrist and spine injuries.
For others, noticeable signs of osteoporosis may include:
- Height loss
- Posture changes (stooping or hunching over)
- A curve in the back
- Back pain
How is postmenopausal osteoporosis diagnosed?
Bone mineral density (BMD) testing is the most common way doctors evaluate bone health.
Generally, doctors recommend that women complete a preventive osteoporosis assessment around age 65 by answering a few questions. If a doctor believes there’s an increased risk of osteoporosis, they may recommend a bone density scan to screen for osteoporosis.
However, if you’re postmenopausal and concerned about your osteoporosis risk factors or you’ve recently experienced a fracture, your doctor will likely recommend that you go ahead with the bone density screening.
The most common BMD test is called dual energy X-ray absorptiometry (DXA), which is like a low-power X-ray scan. Usually the lower back, hip or forearm is scanned, and the resulting images can be used to diagnose osteoporosis, as well as:
- Estimate bone fracture risk
- Estimate rate of bone loss
- Monitor the effectiveness of osteoporosis treatment
How is postmenopausal osteoporosis treated?
Treatment for postmenopausal osteoporosis usually depends on your likelihood of future fractures. If your risk is low, lifestyle changes to manage bone loss, rebuild bone density and minimize your risk of falls may be all that your doctor recommends. In more serious cases, certain medications or therapies may be recommended, such as:
- Bisphosphonates – These are the most commonly prescribed medicines for osteoporosis. They can slow the rate of bone loss, which allows for increases in bone density and decreases in fracture risk.
- Denosumab – Like bisphosphonates, denosumab increases bone density. It also reduces overall fracture risk.
- Hormone replacement therapy – For postmenopausal women, estrogen replacement therapy can increase bone density. Depending on other health factors, modified estrogen (Raloxifene) may be used.
- Other bone-building medications – If other treatments aren’t effective enough or your osteoporosis is severe, you doctor or clinician may recommend other medications. For example, teriparatide and abaloparatide are two that mimic parathyroid hormone, which helps regulate calcium levels in the blood, to trigger new bone growth.
How to prevent osteoporosis before and after menopause
Lifestyle changes can help prevent bone loss as well as rebuild bone density and bone strength if you’ve already been diagnosed with osteoporosis. Examples include:
- Exercise – Strength training can improve muscle and bone strength, while aerobic activity can improve coordination and lower-body conditioning, and balance exercises can help prevent falls.
- Diet – Maintaining a balanced diet that’s rich in calcium and vitamin D is important for both preventing and managing osteoporosis. Calcium helps maintain bone density and strength, and vitamin D helps the body absorb calcium. Ideally, you’d get all the vitamins you need from the foods you eat. However, your doctor may recommend vitamin supplements to help make sure you’re getting the right amount. For postmenopausal women – 1,200-1,500 milligrams of calcium and 800-1,000 international units of vitamin D per day is typically recommended.
- Limiting toxins – Tobacco use and excessive alcohol consumption have both been linked to increased risk of osteoporosis.
Check in on your bone health
When it comes to our bones, out of sight shouldn’t mean out of mind. Keeping our bones healthy and preventing fractures is a key part of maintaining our quality of life as we age.
For starters, try to keep up on your annual checkups with your primary care provider. And when you’re close to 65, talk with them about your risk factors and whether you should schedule an osteoporosis screening.
But if you have concerns about your bone health or are noticing any strange symptoms, don’t wait until your next annual physical. Make an appointment with your primary care provider right away.