Preventing bone loss is an important concern for women in the menopause journey and during post-menopausal stages. Menopause significantly speeds bone loss and increases the risk of osteoporosis. Research indicates that up to 20% of bone loss can happen during these stages and approximately 1 in 10 women over the age of 60 are affected by osteoporosis worldwide.
One in two postmenopausal women will have osteoporosis, and most will suffer a fracture during their lifetime. Fractures (broken bones) cause pain, decreased mobility, and function. Fractures are associated with decreased quality of life and increased mortality.
It is never too late to be treated for osteoporosis, and in fact, older women are more likely to respond better to treatment if given early. The goal of your treatment plan is to decrease fractures associated with osteoporosis and maintain good bone health.
Endocrine Connection
Osteoporosis, which means porous bones, is a progressive condition in which bones become structurally weak and are more likely to fracture or break. Menopause is the most common cause of osteoporosis. As hormones change to accommodate normal menopausal changes, estrogen levels start to fluctuate and then drop. Since estrogen helps prevent bones from getting weaker by slowing the natural breakdown of bone, its reduction during menopause significantly speeds up bone loss.
Estradiol is one of three estrogen hormones naturally produced in the body. The effects of estradiol are clearly seen in women experiencing menopause. During this process, women naturally have lower levels of estradiol as the ovaries no longer produce it, causing the menstrual cycles to stop. This change often causes mood swings, vaginal dryness, hot flashes, and night sweats — the symptoms commonly associated with menopause. Over time, lower estradiol levels can lead to osteoporosis.
Vitamin D and calcium are other hormones that play a part in bone health. Vitamin D allows your body to absorb calcium. Calcium is necessary for building strong, healthy bones. Without enough vitamin D and calcium, bones may not form properly in childhood and can lose mass, become weak, and break easily in adulthood. Even if you get enough calcium in your diet, your body will not absorb that calcium if you don’t get enough vitamin D.
Osteoporosis: A progressive condition in which bones become structurally weak and are more likely to fracture or break.
Osteopenia: Low bone mineral density, the stage prior to osteoporosis.
Bone Turnover Markers: A test in the laboratory of bone resorption or bone formation.
BMD: Bone mineral density is the amount of calcium and other minerals in your bone tissue.
DXA: Dual energy x-ray absorptiometry a test to measure bone mineral density (BMD).
T-score: The units of standard deviation away from the mean for a 35-year-old woman measured by bone mineral density; a negative score means lower bone mineral density than a 35-year-old woman.
Fracture Risk Assessment (FRAX): A measure of the vertebrae to assess whether it has fractured using bone density measurements.
There are many drugs and hormone therapies available to prevent further bone loss and to stimulate new bone formation. Any fracture occurring after menopause should be considered an osteoporotic fracture and should be aggressively treated with one of several possible drugs or therapies:
Bisphosphonates: This oral medication is used to prevent and treat postmenopausal osteoporosis by slowing bone loss while increasing bone mass.
Denosumab: Denosumab is an IV medication that lowers the risk of fractures (bone breaks) and blocks bone loss.
Abaloparatide: This is a bone-building medication that is given as a daily, self-administered injection under the skin for no more than two years. It has been shown to reduce the risk of both spine and non-spine fractures.
Teriparatide: Teriparatide treatment stimulates new bone formation, rather than preventing bone breakdown. This parathyroid hormone increases bone mass by stimulating bone formation and bone turn over.
Romozozumab: A "sclerostin blocker" injected monthly in the doctor's office for 12 months. It's recommended for post-menopausal women at very high risk for fractures.
Tibolone: This is a hormone therapy that helps to relive menopause symptoms and prevent osteoporosis (not available in the U.S. or Canada.
Calcitonin: This hormone comes in a nasal spray that can be used to regulate calcium levels in the body.
Calcium and Vitamin D Supplements: These supplements enhance bone formation and prevent fractures.
Estrogen-hormone Therapy: Prevents osteoporosis by reducing the breakdown of bone, what is also called bone resorption.
Current treatments are very effective and lower the risk of further harm. Duration of treatment will vary depending on a women’s fracture risks, long-term effects of therapy on bone health, and other risks or side effects. Treatments should be a shared decision with you and your healthcare team.
Lifestyle changes that can improve bone health include:
Exercise: A customized exercise regimen supports proper maintenance of the skeleton, including resistance, balance and weight- bearing exercises.
Balanced Diet: Eating foods rich in vitamin D and calcium.
Going Outside: Exposure to sunshine triggers vitamin D production.
Weight Management: Preventing obesity will help keep bones strong.
Smoking and Alcohol: Avoiding smoking and limiting alcohol consumption can reduce your risk of bone loss.
How low is my bone density?
Am I considered high risk for fractures?
Do I need treatment, or can I wait?
What are the side effects of the treatment you are recommending?
Should I be taking supplemental calcium and vitamin D?
Should I see an endocrinologist or any other specialist?
Our physician referral directory is comprised of over 6,500 members of the Society. The referral is updated daily with clinicians who are accepting new patients.
Our physician referral directory is comprised of over 6,500 members of the Society. The referral is updated daily with clinicians who are accepting new patients.
