Stronger Bones, Stronger You: What Women Need to Know About Aging, Menopause, and Bone Health

Menopause may still feel like it’s “down the road,” if you are in your 30’s or 40’s or it already happened if you are in your 50’s, 60’s, 70’s or older. Either way, it is never too late start thinking seriously about bone health.

Why Bone Health Starts to Matter Now

Estrogen does more than regulate periods: it’s a key player in maintaining strong bones. As estrogen levels start to decline during perimenopause, bone loss gradually starts to increase.  By the time menopause hits, usually in your early 50s, bone loss becomes more rapid. Women can lose up to 20% of their bone density in the five to seven years following menopause.  This increases the risk for osteopenia (low bone mass) and osteoporosis.  These conditions can occur silently and lead to serious injuries like hip, spine and wrist fractures later in life.

Early Signs and Risk Factors

You might not notice symptoms of bone loss until a fracture occurs, but here’s some things that can place a patient at increased risk:

• Family history of osteoporosis or osteoporotic fractures (hip/spine/wrist)

• History of rheumatologic disease

• History of renal disease

• Long term steroid medication use

• Low calcium intake, vitamin D deficiency or nutritional deficiencies

• Smoking or heavy alcohol use

• History of premature/early menopause or irregular menstrual cycles as a young adult

If any of these apply, you may want to discuss with your doctor the risks of fracture and your current bone health status.

Bone Maintenance Plan

Regardless of your current age or bone health, now is the perfect time to make your bone health a priority.

1. Diet

• Aim for 1,000–1,200 mg of calcium daily from milk, yogurt, leafy greens, dairy, almonds, or fortified foods.  Many studies show that most people consistently fall short of this recommendation daily. 

• Make sure you're getting at least 800–2,000 IU of vitamin D3 daily.  Vitamin D is crucial to bone health as it aids in absorption of calcium in your diet.  Vitamin D comes from certain types of fish (salmon, Mackerel), fortified foods like cereal, milk and juice, mushrooms, and sunlight.  Some individuals may need vitamin D supplementation if they have a history of vitamin D deficiency.  Due to risk of overdose, it is recommended that patients avoid supplementation over 4000 IU daily unless monitored by a health care professional.  A simple blood test can determine your current level, which can fluctuate based on current diet and time of year.

2. Exercise

Weight-bearing and resistance exercises are an excellent way to strengthen your bones. It is important to focus on three main areas: strength training for power, cardiovascular exercise, and balance/flexibility to help with gait and fall prevention.  Patients should incorporate upper and lower body strength training exercise (like weightlifting) 2-3x per week.  An ideal setup would be at least 8 different exercises split between the upper and lower body per workout session.  Each exercise focuses on 3 sets of 8 repetitions.  Cardiovascular exercise (such as walking, hiking, biking, elliptical, swimming, etc.) for at least 10 to 60 minutes per day.  An ideal goal would be 120-150 minutes per week.  Patients should aim for balance and flexibility exercise 2 times per week for at least 15 minutes per session, such as Pilates, stretching, and/or yoga. 

3. Get Rid of Risky Bad Habits

Smoking and excessive alcohol use can decrease bone density and lead to an increased risk of fracture.  Cutting back or quitting these substances can have a big payoff from a bone health standpoint later in life.  If you are considering eliminating one or both substances, please reach out to a qualified health care professional to help devise the best plan for you. 

4. Get Screened Early If You’re at High Risk

Bone density tests (DEXA scans) are usually recommended at age 65 for women and age 70 for men and are typically covered by insurance.  Unfortunately, significant bone loss occurs in the first 5-7 years after menopause which is often prior to the screening recommendations.  Many experts are recommending early DEXA screening, especially in instances of patient’s high risk for osteoporosis.  These situations can include family history of osteoporosis, rheumatologic or renal diseases, history or long-term use of steroid medications, personal history of fracture, premature menopause, etc.   Even if you do not fit into a high-risk category, you could still receive a DEXA scan as an out-of-pocket expense with a prescription from your health care physician.

5. Hormone and Medication Options

Menopausal hormone therapy/MHT (formerly known as hormone replacement therapy/HRT) may help with menopausal symptoms in women and protect your bones. This treatment is often specific for each patient’s needs but typically involves supplementing the loss of estrogen, progesterone, and/or testosterone.  This treatment is not for everyone depending on a person’s past medical history and family history. There are also non-hormonal options to help prevent or treat bone loss in instances where patients do not wish to receive treatment or are poor MHT candidates.  These options can be discussed with your family doctor, gynecologist, or specialist in menopausal care.

Final Thoughts: Be Proactive, Not Reactive

Now is the perfect time to protect your long-term bone health.  The stronger your bones now, the more mobile, active, and independent you’ll be in your 60s, 70s, and beyond.  Be sure to remain active through cardiovascular and strength training, limit tobacco and alcohol, maintain a healthy diet, and start conversations with your internal medicine doctor and/or gynecologist about the best steps to slow menopausal effects on musculoskeletal health.  You’re not just taking care of your bones. You’re taking care of your future health!