Osteoporosis and menopause
Osteoporosis is a disease that weakens bones, increasing the risk of sudden and unexpected fractures. Literally meaning “porous bone,” osteoporosis results in an increased loss of bone mass and strength. The disease often progresses without any symptoms or pain.
Osteoporosis is often not discovered until the weakened bones cause painful fractures, usually in the back or hips. Unfortunately, once you have a broken bone due to osteoporosis, you are at high risk for another. And these fractures can be debilitating. Fortunately, there are steps you can take to help prevent osteoporosis from occurring. And treatments can reduce the rate of bone loss if you already have osteoporosis.
How is osteoporosis related to menopause?
There is a direct relationship between the lack of estrogens during perimenopause and menopause and the development of osteoporosis. Early menopause (before age 45) and any long period in which hormone levels are low and menstrual periods are absent or infrequent can cause bone loss.
Diagnosis of osteoporosis in young women
Diagnosing osteoporosis in premenopausal women is not easy and can be quite difficult. First of all, bone density tests are not routinely recommended for young women. Here are some reasons why:
- Most premenopausal women with low bone density are not at increased risk of breaking a bone shortly. Therefore, having information about your bone density can only cause unnecessary worry and expense.
- Some premenopausal women have low bone density because their genetic factor (family history) caused them to have low peak bone mass. Nothing can and should be done to change this.
- DXA tests can underestimate bone density in small, thin women. So, a DXA test may indicate that a small person has low bone density, but the bone density is really normal for the person’s body size.
- Medications for osteoporosis are not approved or recommended for most premenopausal women. Jawbone density tests are used to help leader decisions about treatment.
Diagnosing in young women generally involves several steps. While these stepladders may differ for each person, they may include:
- Medical history
- Physical exam
- Bone mineral density test (bone density)
- Lab tests
One to two years after an initial bone density test, a second bone density can be done and will determine if you have a low peak bone mass that remains the same or if you are losing bone. If your bone density drops significantly between the first and second test, you may be losing bone and need further evaluation by a healthcare provider.
Treatments for established osteoporosis include:
- Medications such as alendronate (Binosto, Fosamax), ibandronate (Boniva), raloxifene (Evista), risedronate (Actonel, Atevia), and zoledronic acid (Reclast, Zometa)
- Calcium and vitamin D supplements.
- Weight-bearing exercises.
- Injectable abaloparatide (Tymlos), teriparatide (Forteo) or PTH to rebuild bone.
- Injectable denosumab (Prolia, Xgeva) for women at high risk of fracture when other drugs don’t work.
Understand the risks
The following are additional risk factors:
Smoking has been shown to increase your risk. It also appears to cause an earlier onset of menopause, which means there is less time that the bones are protected by estrogen. People who smoke also have a more difficult time healing after a fracture compared to non-smokers.
Women who are small or thin have a higher risk of developing osteoporosis compared to women who are heavier or have a larger body. This is because slimmer women have less bone mass overall compared to larger women. The same is true of men.
Existing bone density
When you reach menopause, the higher your bone density, the lower your chance of developing osteoporosis.
Think of your body as a bank. You spend your young life building or “saving” bone mass. The more bone mass you have at the beginning of menopause, the less quickly it will “wear out.”
This is why you should encourage your children to actively develop bone density in their younger years.
If your parents or grandparents had this or a hip fracture as a result of a minor fall, you may have a higher risk of developing osteoporosis.
Women are up to four times more likely to develop osteoporosis than men. This is because women tend to be smaller and weigh less than men. Women over the age of 50 are at the highest risk of developing bone disease.