How to manage bone health in women from peri to postmenopause

Perimenopause to Post menopause changes for women & Bone Health changes 

Perimenopause is characterized by increasing menstrual irregularity but less than 3 months of amenorrhea, late perimenopause by amenorrhea lasting greater than 3 months but less than 1 year, and post menopause by the absence of menstrual bleeding for twelve consecutive months or more. The loss of ovarian function during the menopausal transition has a profound impact on female skeletal health¹. Perimenopause is characterized by an increase in bone resorption and reduction in BMD.These findings are accompanied by higher serum FSH levels, although estrogen levels may remain within the premenopausal range during the early transition. There is a direct relationship between the lack of estrogen during perimenopause and menopause and the development of osteoporosis. Early menopause (before age 45) and any prolonged periods in which hormone levels are low and menstrual periods are absent or infrequent can cause loss of bone mass.

The most important risk factor for bone loss in midlife women is the menopause. Women lose about 50% of their trabecular bone and 30% of their cortical bone during the course of their lifetime, about half of which is lost during the first 10 years after the menopause. Although bone loss accelerates after menses cease, it is not clear either when bone loss begins or what the rates of bone loss are at various stages of the menopause transition.

Study of Women’s Health across the Nation (SWAN) was a seven-center, longitudinal cohort study of the menopause transition in a community-based sample of women. It was a large-scale, multiethnic, longitudinal cohort study to assess BMD across the entire menopause transition. The study concluded that bone loss accelerates substantially in the late perimenopause and continues at a similar pace in the first postmenopausal years.²

 Why higher risk of bone loss for Women?

Women tend to have younger onset of bone loss compared with men, at a more rapid pace than men do and they have higher bone resorption markers. Estrogen deficiency plays an important role in osteoporosis development for both genders, and it is more pronounced for women and at younger (menopausal) ages compared with men. Smoking and weight loss are important modifiable risk factors that should be targeted when such patients are evaluated. The periosteal gain in men ameliorates the endosteal bone loss and results in more bone strength compared with women³. Women aged 50 years or older have a four times higher rate of osteoporosis and a two times higher rate of osteopenia compared with men. Women tend to have fractures about 5 – 10 years earlier than men and have a higher lifetime risk of fractures. The excess fractures observed in women may be explained by their smaller bone size and their increased risk of falls.

To do and what not to do to prevent bone loss in women?

 Exercise regularly — weight-bearing exercises (activities that work one’s bones and muscles against gravity) are essential to maintaining bone health.

Ensure adequate calcium intake — Calcium plays a key role in keeping bones strong. Vitamin D is also essential, as it helps ensure absorption and retention of calcium in bones. Calcium and vitamin D requirements vary depending on age and gender

Eat a balanced, healthy diet — certain foods provide excellent sources of calcium, while diets high in protein and/or sodium increase calcium loss.

Quit smoking — Smoking has a detrimental effect on bone density, leading to greater risk of injury and longer recovery times.

Limit alcohol consumption — while the exact way alcohol affects bone isn’t entirely understood, excessive alcohol use has been proven to accelerate bone loss

Ensure receiving optimum amounts of calcium- Calcium can help build strong bones and keep them strong as women age. The National Institutes of Health (NIH) Trusted Source recommends that people ages 19 to 50 get 1,000 milligrams (mg) of calcium each day. Women over 50 and all adults over 70 should get at least 1,200 mg of calcium each day.

If you cannot get adequate calcium through food sources like dairy products, kale, and broccoli, talk with your doctor about supplements. Both calcium carbonate and calcium citrate deliver good forms of calcium to your body.

Ensure receiving optimum amount of Vitamin D-Vitamin D is important for healthy bones, as your body cannot properly absorb calcium without it. Fatty fishes are good sources of vitamin D from food. Sun exposure is the natural way the body makes vitamin D. However, the time it takes in the sun to produce vitamin D varies depending on time of day, the environment, where you live, and the natural pigment of your skin. For those who wish to get their vitamin D in other ways, supplements are available. According to the NIH trusted Source, people ages 19 to 70 should get at least 600 international units (IU) of vitamin D every day. People over 70 should increase their daily vitamin D to 800 IU.

Get regular checkups-During regular check-ups with your health care provider, ask if you’re at risk. Your provider can work with you to evaluate all your risk factors.

The best way to check your bone-density level is a bone-mineral X-ray test. Generally, your provider will recommend you have your first bone-mineral density-screening if you:

Are age 65 or older, also during early menopause without estrogen replacement.

Have broken a bone after age 50.

Have other risk factors such as family history, history of smoking, heavy alcohol use, currently on steroids, treated for breast cancer, thin frame.

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References:

1. Lasley BL, Santoro N, Randolf JF, et al. The relationship of circulating dehydroepiandrosterone, testosterone, and estradiol to stages of the menopausal transition and ethnicity. J Clin Endocrinol Metab. 2002;87(8):3760–3767
2. Finkelstein JS, Brockwell SE, Mehta V, et al. Bone mineral density changes during the menopause transition in a multiethnic cohort of women. J Clin Endocrinol Metab. 2008;93(3):861-868. doi:10.1210/jc.2007-1876
3. Alswat KA. Gender Disparities in Osteoporosis. J Clin Med Res. 2017;9(5):382-387. doi:10.14740/jocmr2970w
4. Sattin RW, Lambert Huber DA, DeVito CA, Rodriguez JG, Ros A, Bacchelli S, Stevens JA. et al. The incidence of fall injury events among the elderly in a defined population. Am J Epidemiol. 1990;131(6):1028–1037