Menopause can have a direct impact on your bone health.
We explore the reasons why and what you can do to keep your bones healthy.
Osteoporosis develops when bone mineral density and bone mass decrease, or when the quality or structure of bone changes. This leads to a decrease in bone strength and increases your fracture risk, even after minor falls from a standing height.
Whilst osteoporosis can affect anyone, it is most common in women, with half of women over 50 expected to develop the disease.
Losing bone density is a natural part of ageing but osteoporosis is not inevitable. There are lots of ways you can minimise your risk and prevent osteoporosis from developing.
In short, yes. Hormones play a direct role in regulating your bone density.
During perimenopause and menopause your body’s level of oestrogen and progesterone drop. This negatively impacts your bone density.
Oestrogen is responsible for regulating bone production and absorption.
As oestrogen levels fall, more bone is reabsorbed than produced. This leads to a decrease in bone mineral density.
Oestrogen supports calcium absorption in the intestine. Reduced oestrogen levels means even if you’re getting the right levels of calcium, less of it is absorbed and used by the body.
Progesterone compliments the effects of oestrogen by promoting bone formation.
Like oestrogen, progesterone levels fall during menopause. This decreases bone production and further reduces bone density.
Bone density doesn’t just decline post menopause.
Bone density reaches its peak when your around 30. Thereafter your bone density starts to slowly decrease.
Through a process known as remodeling, old bone is reabsorbed and replaced with new bone. This process helps keep your bones strong and regulate calcium levels in the blood.
After 30, more bone is broken down than is replaced. Over time this decreases bone density, first leading to osteopenia and then osteoporosis. This process is accelerated by perimenopause and menopause.
Perimenopause is the time when your body starts its natural transition to menopause. It’s often described a ‘hormone rollercoaster’ due to the changing levels of hormones.
Oestrogen and progesterone levels rise and fall unevenly though perimenopause, disrupting the menstrual cycle and causing symptoms such as hot flushes. Although hormone levels can spike, overall they will drop as you progress through perimenopause.
During perimenopause, most women start to lose some bone mass.1 This decrease is less than is lost following menopause.
Oestrogen and progesterone levels drop to permanently low levels following menopause.
This has a significant impact on bone density, with most women expected to lose 20% of their bone density in the 5-7 years following menopause.
Without treatment and lifestyle changes this can increase the risk of you developing first osteopenia (bone density which is below average) and then osteoporosis.
Whilst menopause is inevitable, osteoporosis isn’t. There are lots of natural ways to increase your bone density and prevent the disease.
Unlike your other menopause symptoms such as hot flushes, osteoporosis is a silent disease and has no obvious warning signs. Often people don’t know if they have osteoporosis until after they’ve already suffered a fracture.
The best way to understand your bone health is by having a DEXA scan done.
A DEXA (Dual-energy X-ray absorptiometry) scan is the gold standard for measuring bone density in the UK, recognised by the NHS and the Royal Osteoporosis Society.
The scan uses a very small level of radiation to record the density of minerals in your bones (mainly phosphorous and calcium).
Results are given as T and Z scores. Your T-score is the difference between your bone density and that of an average healthy adult of your gender. Your Z-score is the difference between your bone density and the average of someone your age and gender. T-scores are the ones used to diagnose osteoporosis as they compare your results to a healthy baseline.
A T-score between +1 and -1 indicates normal bone density
A T-score between -1 and -2.5 shows you have low bone density which may develop into osteoporosis (also known as osteopenia)
A T-score at or below -2.5 shows severe bone loss and is diagnosed as osteoporosis
Osteoporosis is a disease and doesn’t have to be an inevitable part of ageing.
The good news is there’s lots you can do about it. And the earlier you start, the better!
Exercise is important for your overall health, including your bones.
Many of the body’s natural biological process are influenced by vibrations or mechanical signals. Mesenchymal stem cells (MSCs) have the potential to form bone, cartilage, or fat cells. Without stimulation mesenchymal stem cells begin to hibernate or grow into fat cells.
Exercising regularly sends a consistent signal to these cells and ensures more MSCs develop into bone and muscle cells, not fat.2
The best exercises for increasing bone density, are weight bearing exercises. This doesn’t mean you have to lift heavy weights (but, by all means do if that’s your thing!)
Weight-bearing exercise is any exercise where you are standing, with your full body weight pulling down on your skeleton. This includes anything from gardening to tennis. The most important thing is you exercise in a way you are comfortable with and will be able to do consistently.
Exercise has been found to help reduce other menopause symptoms, including hot flushes. One study found exercise reduced sweating and arterial pressure during hot flushes.3
What you eat has a direct impact on your bone health. Eating a varied diet rich in the right vitamins and minerals is important for maintaining your bone health. Here’s some of the main ones to watch out for:
You’ve probably already heard calcium is great for your bones, but how much a day do you need?
The NHS advises most people should be able to get the calcium they need from their diet from foods such as dairy products and dark leafy green. Kale for example contains 250mg per 100g – that’s about a quarter of your recommended 1000mg daily intake.
Be careful if taking calcium supplementation as too much can be bad for you and cause conditions such as hypercalcemia. The Royal Osteoporosis Society advises you shouldn’t exceed 2500mg per day.
Often known as the sunshine vitamin, your body can produce its own vitamin D when exposed to sunlight. Vitamin D is found in smaller amounts in foods such as fish and eggs.
In the UK, your body only reliably gets vitamin D from sunlight between March and September. NICE and PHE advises everyone should consider vitamin D supplementation during winter. Like calcium, too much vitamin D can be dangerous. Check with your doctor or GP what the correct amount for you is.
Calcium and vitamin D are not the only minerals to look out for. Other vitamins such as vitamin K, C, and magnesium play important roles.
Visit the Royal Osteoporosis Society for more information on nutrition and your bone health
HRT, or Hormone Replacement Therapy, is medication which mimics the effects of the oestrogen and progesterone.
By replacing the oestrogen and progesterone lost during menopause, HRT can help prevent osteoporosis, especially if you have an early menopause.
Historically HRT has been linked with an increased risk of breast cancer. Recent research suggests HRT is safe when prescribed correctly, and using it only carries a small increased risk of breast cancer.4
Low-intensity Vibration (LiV) therapy works in a similar way to exercise. By sending precise, targeted vibration signals to the MSCs in your bones, LiV therapy has been shown to prevent osteoporosis and increase bone density through each stage of menopause.5
The Marodyne LiV device is designed to be used at home and can be used as a standalone therapy or to support other treatments, exercise regimes and positive lifestyle changes. Each session only takes 10 minutes a day.
Unlike other forms of vibration therapy, LiV therapy is safe and has no contraindications or side effects.
Find out more the Marodyne LiV Device
1 Lo, Joan C et al. “Bone and the perimenopause.” Obstetrics and gynecology clinics of North America vol. 38,3 (2011): 503-17. doi:10.1016/j.ogc.2011.07.001
2 Pagnotti, Gabriel M et al. “Combating osteoporosis and obesity with exercise: leveraging cell mechanosensitivity.” Nature reviews. Endocrinology vol. 15,6 (2019): 339-355. doi:10.1038/s41574-019-0170-1
3 Bailey, Tom G et al. “Exercise training reduces the acute physiological severity of post-menopausal hot flushes.” The Journal of physiology vol. 594,3 (2016): 657-67. doi:10.1113/JP271456
4 Vinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of breast cancer: nested case-control studies using the QResearch and CPRD databases BMJ 2020; 371 :m3873 doi:10.1136/bmj.m3873
5 Rubin, C., Recker, R., Cullen, D., Ryaby, J., McCabe, J. and McLeod, K. (2004), Prevention of Postmenopausal Bone Loss by a Low-Magnitude, High-Frequency Mechanical Stimuli: A Clinical Trial Assessing Compliance, Efficacy, and Safety. J Bone Miner Res, 19: 343-351. https://doi.org/10.1359/JBMR.0301251
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