As a Family Medicine Physician, many of my patients over 40 come to talk with me about perimenopause or menopause. However, I always make it a point to bring up bone health as well, because the risk of osteoporosis spikes at the transition to menopause.
Osteoporosis, which causes bones to become brittle and more likely to break, can be serious. It sets the stage for fractures that can affect your independence. But I remind my patients that they have the power to reduce their risk significantly. And it all starts with simple lifestyle changes.
Here are the habits I encourage — and that I hope you'll consider too.
Understanding bone loss
Osteoporosis is marked by bone loss. But what does that actually mean?
I explain to my patients that bone is living tissue. The body continuously reabsorbs and replaces bone tissue using minerals like calcium and phosphate. Your entire skeleton is replaced roughly every 10 years, though the process slows a bit as we age.
Our bones stay sturdy and strong when there's a good balance of old and new. But when the body begins to reabsorb old bone faster than it creates new bone, a person starts to experience bone loss. This causes bones to become brittle and weak. When enough bone loss occurs, a person has osteoporosis.
Bone loss can happen as a natural result of aging. But decreased estrogen during perimenopause and menopause also plays a key role. As I warn my patients, people who menstruate go through a three-year period of rapid bone loss, beginning about a year before their last period.
This decline can't be prevented. But with a little know-how, we can minimize it.
5 ways to help prevent osteoporosis
My big bone-health message for patients: The sooner you start taking steps to protect yourself, the better. Here are five ways to get started.
1. Prioritize calcium and vitamin D
Calcium is the main ingredient for building and maintaining healthy bones, so aim for 1,000mg daily. You can get there with three cups of skim milk. Other good sources include:
- Yogurt
- Cheese
- Dark, leafy greens
- Almonds
- Sardines with the bones in
To absorb calcium, your body also needs vitamin D. So make it a point to eat vitamin D-rich foods, too, and aim for 800 to 1000 international units (IU). Find it in:
- Fortified breakfast cereal
- Fatty fish, like salmon or mackerel
- Fish liver oils
- Egg yolks
You can also get vitamin D from exposure to direct sunlight. (Because of the risk of skin cancer, I still recommend wearing sunscreen regularly and increasing vitamin D through diet or supplements instead.)
2. Stay active
Exercise is tied to higher bone mass and stronger bones. Try to get at least 150 minutes of exercise per week, or about 30 minutes per day. Weight-bearing exercises are the most effective, as they apply force to bones, making them work harder. Examples include:
- Brisk walking
- Jogging
- Tennis
- Pickleball
- Resistance training
- Dancing
- Climbing the stairs
It's a good idea to work in some non-weight-bearing activities too — think tai chi, yoga, or Pilates. These kinds of exercises can improve your balance and posture, reducing your risk for falls and fractures.
3. Ask your doctor about screening
Bone density tests can help catch osteoporosis sooner, before it becomes severe. Our go-to tool is the DEXA scan (or DXA scan). It's quick and easy: You lay down for 3 to 10 minutes while a machine scans your body to measure the density in areas like your heel, spine, hip, or wrist.
Everyone over 65 should have a bone density test. But some people should start sooner. Ask your doctor about your individual risk factors.
4. Be mindful of alcohol and avoid smoking
Alcohol can damage your bones and increase your fracture risk. Cigarette smoke can weaken your bones, too, including secondhand smoke. Steer clear if you can.
If you smoke, ask your doctor for help with quitting. Your bones — and the rest of your body — will benefit.
5. Take medications, if needed
We have good medications for osteoporosis. Some work preventively to help bones maintain their density and strength. Some slow down bone loss that's already happening. Your doctor may recommend an option such as:
- Bisphosphonates
- Calcitonin
- Estrogen agonist/antagonists
- Estrogen and hormone therapy
- Parathyroid hormone (PTH) analog and parathyroid hormone-related protein (PTHrP) analog
- RANK ligand (RANKL) inhibitor
Take the next step
Temple's Family Medicine team is here to help you stay healthy throughout life’s changes — including menopause. Request an appointment online or call 800-TEMPLE-MED (800-836-7536).
