While I have been in my rabbit hole of menopause research, they always talk about bone health. When I see that title, I think *yawn* *snore* *skip chapter. *
But then I think about hip fractures, and in older people there is a general rule of thumb: your MORTALITY from getting a hip fracture is around your age. So if you fall at age 80, the chance you will die within the next year after a hip fracture is 80%. (!!!) I don’t know if this stat is still totally accurate, but it has stuck with me since medical school. Then I’m reading this menopause book, (one of many. this one is Jen Gunter MD Menopause Manifesto- it is awesome, and super readable and informative) and her chapter on bone health starts with a quote she heard at a lecture “I am here to scare you about osteoporosis.”
Given all the things we need to be scared about in this world (drought, global warming, politics, covid, buying a bathing suit), I’m just going to add this to the growing list.
What have I learned about bone health?
- It starts declining in your 20s
- Estrogen helps bone formation, so rapid bone loss starts in perimenopause, and then after menopause continues at a faster clip.
- If you have early menopause, you have a fracture risk 1.5-3x higher than those who have menopause after age 50
- Low Calcium and Vitamin D. We tend to be deficient in D (sunscreen? screen time?) and many of us need to be supplementing. If you read my blogs you can see that Vitamin D is great to fight a whole host of things, and it is one of the only vitamins shown to actually make a difference when you take it (most other supplements are mixed in their reviews, and some actually increase morbidity and mortality). Check your level, and then supplement as instructed. As with all things, more is not necessarily better. I had a patient in liver failure once from taking too much D. Calcium– when is the last time you had a glass of milk? Though milk consumption didn’t reduce osteoporosis, a post menopause woman needs 1200mg a day of calcium. More just gets peed out or increases your risk of kidney stones and other things. Again more is not better.
- EXERCISE, especially putting stress on bone and weight bearing. It actually stimulates the cells that build bone to do more. Working on balance is good to PREVENT falls and working on posture prevents the hunchback you can get as you age.
- Alcohol (more than 3 drinks/day) higher risk
- Body weight. Yes, those super skinny women have a higher risk of osteoporosis. Is it due to nonovulation? poor calcium intake?
- Meds. steroids, antiestrogens for breast cancer, and some say heavy use of pot
- Smoking. Yes, it is bad for everything.
One study cites that 50% of women 50 and older have low bone mass or osteoporosis, with white women having the highest risk. If you got a fracture for almost “no reason” you need to get a work up. That is often a heralding sign of osteoporosis.
How to test?
- Bone density scan- dual energy xray absorptiometry or DXA “dexa” or bone mineral density test
- They look at your spine and femur
- It is usually done at age 65, though you can evaluate if you need to start screening earlier:
TEST ONE
Weight in kg minus age in years x 0.2. So if you are 150 pounds, your weight in kg is 68. So if you are hitting menopause, age 52, the score would be: 68 – 52 = 16 x 0.2 = 3.2. A score less than 2 is associated with increased risk, and you should consider a bone density test.
TEST TWO
FRAX TOOL, a fracture risk assessment tool. This is a free online screen out of England. It asks for weight, height, if you have previous fractures, is you smoke, if you drink 3 drinks a day. You can do it without the BMP (the bone density scan result) and it will give you an estimate of your fracture risk for the next 10 years.
So what can you do?
EXERCISE
- You need to increase weight bearing. squats, deadlifts, jumping and drop landings
- 75 minutes of vigorous or 150 minutes of moderate minimum activity/week
BETTER HABITS
- Learn how to pick up things by bending your hips, not your back
- There are tips at the National Bone Health and Osteoporosis Foundation HERE: They talk about diet, exercise, fall prevention and other issues.
TREATMENT ** THIS IS NOT MEDICAL ADVICE. These are potential treatments, and you should discuss with your doctor if you have issues with bone density
- Bisphosphonates. Can be oral or IV.
- Hormone replacement therapy.