The Link Between Osteoporosis and Menopause

Going through menopause can increase a woman’s risk of developing osteoporosis. A main reason for the increased risk is reduced estrogen, which can cause bone loss.

Estrogen generally protects your bones, but when you reach menopause, your estrogen levels drop. That drop can lead to bone loss, and left untreated, bone loss can eventually lead to osteoporosis and osteoporotic fractures.

Keep reading to learn about the link between osteoporosis and menopause.

What Is Osteoporosis?

Osteoporosis is a bone condition that causes bones to become thin or weak over time, which can make them easier to break. It affects people of any sex or gender.

According to the National Osteoporosis Foundation (NOF), up to 10 million Americans have osteoporosis, and 80% of them are women. When over age 50, one in two women and one in four men will experience an osteoporosis-related fracture at least once.

Women have a higher risk for osteoporosis because they have smaller, thinner bones compared to men. Having smaller, thinner bones also means less bone mass. Another factor is that menopause has a greater effect on bone health. These differences mean women will have faster bone loss than men.

Women can lose up to 20% of bone density during the five to seven years following menopause. And the quicker the bone loss is, the greater the risk is for developing osteoporosis.

What Is Menopause?

Menopause marks the end of a person’s menstrual cycles. It is diagnosed after they have not had a menstrual period for 12 months. This can happen at any time during a person’s 40s or 50s. The average age for menopause in the United States is 52.

While menopause is a natural process, physical symptoms like hot flashes and mood swings can disrupt sleep, affect emotional health, and cause you to feel fatigued and have reduced energy levels.

Fortunately, there are treatments, including lifestyle adjustments and hormone therapies, that can reduce discomfort and manage harsh symptoms of menopause.

Menopause Can Contribute to Osteoporosis

The causes of osteoporosis are not always clear, but researchers do know that there is a specific connection between menopause and osteoporosis. The lack of estrogen, a natural effect of menopause, is causally related to decreases in bone density. And the longer a person experiences low estrogen levels, the lower their bone density might be.

Women who are at greater risk for osteoporosis include those who:

• Experience menopause before age 45
• Go for a long time without menstrual periods
• Have very irregular periods, a sign that they are not ovulating regularly

As a person enters menopause, their estrogen and progesterone levels begin to drop. Estrogen naturally protects and defends bone strength. The lack of it contributes to reduced bone strength and the development of osteoporosis. But decreased estrogen isn’t the only risk factor for osteoporosis.

Other Risk Factors

Additional factors might increase a woman’s risk for osteoporosis. For instance, women whose parents or grandparents had osteoporosis might be at a higher risk for the condition.

Women who are extremely thin or petite might also have a higher risk of osteoporosis than women who are heavier or have larger body frames. This is because thinner women have less bone mass.

Race and ethnicity may play a part in a woman’s risk, as well. A 2011 study found the highest fracture rates were in White women. Despite higher bone mineral density in Black women, they are more likely to have poor outcomes after a hip fracture. There are also ethnic and racial disparities in screening and health care for osteoporosis.

Another risk factor is diet. Both calcium and vitamin D generally help the body maintain healthy and strong bones. If you are not getting enough calcium, your body will use what it has stored in the bones, which can leave your bones weak and vulnerable to breaks. The body also needs vitamin D to absorb calcium.

Additional factors that might increase the risk for osteoporosis are smoking and drinking alcohol in excess.

These risk factors, combined with decreased estrogen and reduced bone mass and density that naturally occur with age, may cause osteoporosis to begin earlier or develop faster. Reach out to your healthcare provider if you think any osteoporosis risk factors apply to you.

Your healthcare provider can check your bones for bone loss using a type of imaging called dual-energy X-ray absorptiometry (DEXA) scan. These scans can help determine if you need medicines to strengthen bones.

Preventing Osteoporosis

There are many ways to protect yourself against osteoporosis, particularly as you enter menopause. Ways for you to maintain bone and muscle strength, prevent bone loss, and reduce fracture risk include:

Exercise

Exercise can help your bones and muscles to become stronger and prevent bone loss. According to the National Osteoporosis Foundation, weight-bearing exercises can be helpful when done for 30 minutes on most days of the week. You can either do one 30-minute session a day or multiple sessions throughout the day.

The NOF notes that the benefits are the same. Examples of weight-bearing exercises are walking, jogging, dancing, elliptical training, stair climbing, and gardening.

Eat a Bone-Healthy Diet

Women should aim to eat foods high in calcium and vitamin D. For post-menopausal women, the recommended daily allowance (RDA) of calcium is 1,200 milligrams (mg) per day.

Excellent sources of calcium are milk and other dairy products, canned fish with bones (such as salmon and sardines), dark green leafy vegetables, and calcium-fortified foods, such as orange juice.

Don’t Forget Vitamin D

Your body uses vitamin D to absorb calcium. Being out in the sun for at least 20 minutes a day can help your body to produce enough vitamin D. You can also get vitamin D from your diet. Foods that are rich in vitamin D include eggs, fatty fish, cereals, and milk fortified with vitamin D.

Older adults ages 50 to 70 should aim for at least 600 IUs and no more than 4,000 IUs of vitamin D per day. Check with your healthcare provider before taking vitamin D supplements. They can test your vitamin D levels to determine if supplements are necessary.

Nix the Bad Habits

Smoking and drinking heavily harm your bone health. If you are underweight, your risk for osteoporosis and fractures is higher. Therefore, aim to keep your body weight in a healthy range.

Check Your Bone Health

Once you reach menopause, visit your healthcare provider regularly to assess your bone health and fracture risk. If your healthcare provider diagnoses you with bone loss, you should follow the treatment plan they prescribe. Treatment might include medications called bisphosphonates to improve bone strength and reduce fracture risk.

Know Your Risk

Educate yourself about risk factors for osteoporosis and which of those might apply to you. Risk factors that might apply to women include:

• Early menopause
• Corticosteroid use
• Autoimmune disease like rheumatoid arthritis
• Malabsorption disorder like celiac disease
• History of weight loss surgery
• Eating disorders

Estrogen Replacement in Some Cases

Replacing estrogen that is lost after menopause can slow down bone loss and improve the body’s ability to absorb and retain calcium. But estrogen therapy comes with risks, including increasing the risk for breast cancer, and thus it is no longer considered first-line treatment for postmenopausal osteoporosis.

It is only considered for women with persistent menopause symptoms who also have an indication for treatment for osteoporosis who cannot tolerate the other therapies.

A Word From Verywell

Osteoporosis is called a silent disease because it is often diagnosed after a person sustains a fracture. While it may not always be preventable, it can be diagnosed early using bone scan technology that measures the reduction of bone density. 

As you near menopause, you should discuss risk factors for osteoporosis with your healthcare provider, especially if osteoporosis runs in your family. Fortunately, there are medicines to prevent further bone loss and even stimulate new bone formation.

If you experience a fracture after menopause, talk to your healthcare provider about whether it might be an osteoporotic fracture and what treatment might help to prevent future fractures.