Menopause and osteoporosis

Menopause is about so much more than just the end of your periods. The health impacts for some can be serious, and one of the most significant concerns is the risk of developing osteoporosis. Learn about how menopause impacts bone health and ways to support your bones as you age.

Oestrogen is one of the primary female sex hormones. It plays a crucial role in many bodily functions including supporting strong and healthy bones.¹ During menopause, the body stops producing as much oestrogen. As oestrogen levels in the body decrease, so does bone density.

In the first 5 years after menopause, women may lose up to 10% of their bone mass, putting them at a higher risk of osteoporosis.²

It’s estimated that 23% of women over the age of 50 in Australia have osteoporosis.^3,4

Osteoporosis⁵ is a musculoskeletal condition characterised by weak, brittle bones that are prone to breaks. People often don’t know they have osteoporosis until they experience their first fracture or break.

Whereas people with healthy, dense bones only tend to experience bone breaks with severe injury, those with osteoporosis can fracture a bone doing something as simple as carrying a heavy load, bumping into something, or even coughing or sneezing.

Having weak bones that are prone to breaking can have a serious impact on your quality of life and mobility. There is growing evidence to suggest that bone loss increases the risk of depression in postmenopausal women.⁶

Oestrogen levels drop dramatically after menopause (at an average age of 51), significantly increasing the risk of osteoporosis.⁷

It’s essential that menopausal and post-menopausal women, including those assigned female at birth, support their bone health to help reduce that risk.

The good news? We can support our bone health as we age through diet and exercise says Jana Labiris, a Bupa health coach and dietitian.

“While we cannot influence some risk factors, such as a family history or presence of disease, there are many things we can do to significantly reduce the risks menopause poses for developing osteoporosis,” says Jana.

Before menopause, women need around 1000mg of calcium every day to support bone health. Post-menopause, this increases to 1300mg per day.⁸

Calcium-rich foods include dairy (milk, yoghurt and cheese), leafy green vegetables such as kale, broccoli and silverbeet, fish with edible bones such as sardines, and tofu.

You can also buy calcium-fortified spreads, cereals and drinks.⁹ Check the ingredients and nutritional information on food labels to see what vitamins and minerals have been added.

200g pot of plain yoghurt or one cup of milk = 200-300mg of calcium.

One cup of canned salmon = 200-300mg of calcium.

One cup of cooked broccoli = 45mg of calcium.

One cup of tofu = 252mg of calcium (more if made with calcium sulfate).

2 slices of bread = 24mg of calcium.

30g of cheddar cheese = 240mg of calcium.¹¹

Always check the label for the exact information, as brands may vary.

“It might sound like a lot, but it is possible to get enough calcium through diet¹⁰,” says Jana. “1300mg is equal to 4 servings of dairy a day. So, if you’re having a milky coffee and some yoghurt for breakfast, 2 slices of cheese with lunch and a leafy green salad with chickpeas and beans for dinner, you’re on the right track.

“Try snacking on figs and raisins, a handful of almonds and an orange during the day for an extra calcium hit. And throw some chia seeds in with your yoghurt. These are all calcium-rich foods that are also low in saturated fats and high in protein, so they’re also helping to protect your heart health and your lean muscle mass.”

For anyone who has heart disease, it’s recommended to choose reduced-fat yogurt, milk and cheese.¹²

If you are struggling to get enough calcium through diet alone, you may be able to take a calcium supplement.

Speak to your GP or pharmacist for advice before taking any supplements or medications, as they may not be right for you.

Vitamin D is important for bone health because it helps the body absorb calcium from food.¹³

The primary source of Vitamin D is sunlight. During and after menopause, you should ensure you get 15-30 minutes of sunlight most days of the week to maintain a good level of Vitamin D. On a cloudy day or during winter, most of us will need more than 30 minutes per day.

Don’t forget to practice sun safety and limit your exposure during the hottest parts of the day.¹⁴

Some foods contain Vitamin D. Dietitians Australia state that good dietary sources of Vitamin D include:¹⁰

• fatty fish such as salmon, herring, sardines and mackerel
• eggs
• mushrooms
• fortified margarines, milk and yoghurt

“It’s extremely difficult to get the recommended amount of Vitamin D from diet alone,” says Jana. “Look for Vitamin D fortified foods and safely expose yourself to sunlight when you can.”

Top tip: Mushrooms can absorb Vitamin D from sunlight. Leave mushrooms in the sun, gills-side up, for 15 minutes before eating, for a quick Vitamin D boost to your diet.¹⁴

While you might think that exercise increases your risk of a broken bone in later life, it’s vital that during menopause, and in the years that follow, we support bone health through keeping fit.

Ironically, exercise that stresses our bones can be the most helpful! Walking up and down stairs, fast walking, running or jogging, dancing and sports such as tennis force our bones to work harder, which makes them stronger.¹⁵

Exercise that improves balance can help reduce the risk of falling, and strength-based exercises such as weights or resistance bands puts stress on bones, making them stronger, and help keep the muscles around the bones strong.

“Exercising every day for a minimum of 30 minutes, plus 2-3 sessions per week of weight-based or resistance training, and a session of balance training, all help protect our bones as we age,” says Jana.

“Remember, you can split the 30 minutes up into 10-minute blocks if that’s easier, and there are no rules to say how heavy your weights need to be. Body weight exercises, such as push-ups and squats, count too. Do what feels good for you or talk to a physio or exercise physiologist for some advice.”

Consult your GP or an exercise or sports physiotherapist before beginning any new exercise regime.

Smoking is a major risk factor for osteoporosis. It can lead to lower bone density, making bones more fragile and susceptible to fractures. It also causes fractures to heal more slowly. Excessive alcohol consumption is also linked to reduced bone density.

“We know that smoking and alcohol can negatively impact bone health, can affect how well calcium is absorbed by the body and can disrupt the production of oestrogen,” says Jana.

“There is also risk of impairment when drinking alcohol that increases the risk of falling.”

Speak to your GP if you need support to quit smoking or would like to have a better relationship with alcohol.

If you are concerned about your bone health, speak to your GP.

If necessary, you may be referred for a bone density scan, also known as a DEXA scan.¹⁶ This quick, painless procedure uses a special kind of X-ray that can measure bone density.

Your bone density will be classified as normal, low (osteopenia, which can be a precursor to osteoporosis if left untreated), or osteoporosis. The results will be sent to your GP, who will discuss the best treatment with you, including lifestyle management around diet and exercise.

Your doctor may also prescribe medication based on your bone density results and health needs. Osteoporosis medication can be in the form of a tablet, patch, injection or infusion.¹⁷

The Australasian Menopause Society has resources online, including information on how to reduce your risk of osteoporosis post-menopause.

Healthy Bones Australia provides advice on how to prevent bone breaks and a comprehensive list of calcium-rich foods to include in your diet.