Bone health and menopause: what’s the connection?

Menopause negatively affects bone health due to a decline in oestrogen levels, which accelerates bone density loss. This increases the risk of osteoporosis, making bones weaker and more prone to fractures. Dr Ashlesha Dhairyawan, an experienced menopause specialist, who is accredited by the British Menopause Society, explores the link between menopause and osteoporosis.

What is the link between menopause and osteoporosis?

Our bones are continuously broken down and rebuilt by specialised cells in a process called bone remodelling, which keeps them healthy and strong. Peak bone mass is usually reached by our mid-twenties, after which bone remodelling continues throughout life.

During menopause, the decrease in oestrogen disrupts this balance, leading to more bone breakdown than formation. This results in rapid bone loss for several years around menopause, followed by a slower but steady decline as a person ages. This bone loss can lead to osteoporosis, a condition where bones become thin and fragile, increasing the risk of fractures from falls or impacts.

Osteoporosis often goes undiagnosed until a fracture occurs. It is a common condition, affecting 1 in 2 women and 1 in 5 men over the age of 50. Globally, around 9 million women suffer fractures due to osteoporosis each year, equating to one fracture every three seconds.

What is the connection between hip fracture and menopause?

One out of every three women aged 50 and older will experience a hip fracture, which carries serious health implications. After the first fracture, there is five times increased risk of fracture in the following year, significantly impacting quality of life as daily tasks like bathing, dressing, and shopping may require assistance.

Forty percent of women who fracture a hip may lose mobility and independence. The psychological and physical effects can be substantial. Genetic factors, such as a family history of osteoporosis, notably increase risk and cannot be altered.

How can women reduce the risk of fractures?

There are additional factors that can be modified to reduce risk, including smoking, consuming three or more alcohol units daily, having a low body weight (BMI less than 18.5), or having a diet deficient in calcium and vitamin D. Women who experience early menopause or undergo surgical removal of ovaries before age 40 are also at higher risk for osteoporosis and fractures.

Other risk factors include certain medications like oral steroids and some antidepressants. Diagnosis of osteoporosis typically involves a DEXA scan to measure bone mineral density. This scan is recommended based on family history, increased risk factors, or prior low-impact fractures.

What treatments are available?

Fortunately, treatments are available for osteoporosis. For those already diagnosed or at high risk of fractures, numerous studies confirm that oestrogen therapy in hormone replacement therapy (HRT) strengthens bones and reduces fracture risk. Oestrogen is effective both as a preventive measure and a treatment for osteoporosis.

Starting HRT is particularly crucial for women who experience early menopause before age 40, significantly lowering their risk of osteoporosis and fractures. High-impact weight-bearing exercises such as running, dancing, aerobics, and strength training exercises are beneficial for maintaining strong bones.

A balanced diet is essential for bone health, with a daily requirement of 700mg of calcium found in green leafy vegetables, dried fruit, and dairy products. Vitamin D, crucial for bone strength, can be obtained from oily fish, egg yolks, and sunlight exposure; a supplement may be necessary during winter months or with inadequate dietary intake.

If you would like to book a consultation with Dr Dhairyawan, do not hesitate to do so by visiting her Top Doctors profile today.