Learn how menopause affects bone health and increases osteoporosis risk, plus steps you can take to protect your well-being before, during, and after menopause.
This resource is part of a brief series on the importance of understanding menopause.
1. Understanding Menopause | 2. Menopause and Osteoporosis (current)
While we use the term “woman” in this article, we recognize that menopause is a life stage that can be experienced by transgender, non-binary, and gender-diverse people too.
Osteoporosis is a medical condition where the bones become fragile and are at increased risk of fracture (broken bone). Rapid bone loss occurs around the time of menopause, and after menopause, bone loss continues. Learn about how you can reduce your risks.
Good bone health is important at any age but becomes more important as we age. Throughout our entire life, our bones are constantly being remodeled or restructured. Specialized cells are constantly removing and replacing bone throughout life to repair damage, prevent accumulation of old bone (which can be become brittle). Calcium and phosphorus from the bones can also make up for deficiencies in the diet or during pregnancy and lactation. Women typically reach their peak bone mass in their late twenties. Once the peak bone mass is reached, women begin to lose bone mass at a very small rate (<0.4% per year).
Bone health is influenced by a number of factors:
Genetic make-up
Nutrition: calcium, phosphorus and vitamin D
Physical exercise (especially weight-bearing exercise)
Lifestyle such as smoking, drinking alcohol
Hormone production
Medications (e.g., long-term use of prednisone, some antiseizure medications, overuse of aluminum-based antacids)
Medical conditions
How does menopause affect bone health?
As we age, bone formation decreases and typically fails to keep up with bone resorption, leading to bone mass loss over time. In women, the steep and sudden decline in estrogen plays a major role in this process. This rapid loss of bone starts about a year before the last menstrual period and continues for about three years.
Women can lose 6% of their bone mass during this three-year period, but some women may lose even more; up to 3-5% per year, leaving them at a much higher risk to develop osteoporosis. Because research has shown that women of colour tend to enter menopause earlier, bone density loss also occurs earlier. This means that osteoporosis can occur earlier, leading to more fractures in early old age. Bone loss continues after this period of rapid loss, but at a higher rate than before menopause; in some women it may be as high as 1% per year. Maximizing bone health in premenopausal and early perimenopausal women is paramount for overall health and longevity.
Many people have weak bones even before menopause is brought into the mix due to lifestyle, poor nutrition, or factors related to genetics. As bone mass decreases, structural abnormalities develop, the skeleton becomes more fragile, and risk of fractures increases. As a result, postmenopausal osteoporosis can occur from a failure to reach peak bone density in early adulthood, accelerated bone loss after menopause, age-related bone loss, or a combination of these factors.
What are the potential outcomes associated with osteoporosis?
Osteoporosis is a common condition affecting over 2.3 million Canadians, with at least one in three women suffering from a fracture due to osteoporosis in their lifetime. In fact, fractures from osteoporosis are more common than heart attack, stroke, and breast cancer combined. The most common locations of fractures associated with osteoporosis are in the hip, spine, wrist, and shoulder.
Osteoporosis is often called the silent thief because bone loss occurs without symptoms and goes unnoticed until a bone is fractured. Facts about osteoporosis:
More than 80% of fractures in people over 50 are caused by osteoporosis.
Individuals who have already experienced a fractured bone may be at higher risk for another fracture.
Experiencing a hip or spinal fracture puts individuals at very high risk for another fracture.
Over half of hip fracture patients will suffer another fracture within 5 years.
Hip fractures in older people are extremely serious, often leaving them disabled.
Twenty two percent of women who suffer a hip fracture will die within a year.
About 80% of those living with diagnosed osteoporosis are women.
Reducing the risks
Fractures due to osteoporosis are called fragility fractures and can result from falls from a standing height or less (trip, slip, stumble) at a walking speed or slower, or even from coughing, sneezing, reaching for or lifting objects, including a small child, or bending over to pick up a pet dish or make a bed.
The good news is, you can reduce your risk:
Participate in weight-bearing and high impact exercise (brisk walking or running, playing tennis or pickle ball, climbing stairs, dancing, weight training). Improved muscle strength is correlated with higher bone density.
Limit caffeine or alcohol, as both can contribute to bone mass loss.
Quit smoking.
Incorporate foods rich calcium including:
Milk, soup made with milk, main courses made with cheese such as lasagna, or yogurt. A 3 cm cube of hard cheese has as much calcium as a cup of milk. Dairy products are an excellent source of calcium and are also a good source of protein.
If you’re intolerant to dairy or are vegan, incorporate, calcium-fortified soy, almond, and rice beverages, calcium-fortified orange juice, canned salmon or sardines (consume the bones to get the benefits).
Almonds, beans (white, navy, pinto, chickpeas), and figs are also good sources of calcium.
Many foods in Canada are fortified with vitamin D so check labels. Other sources include: Cod liver oil and fish such as salmon, swordfish, tuna, and snapper.
Speak to your primary care provider:
regarding the right calcium and vitamin D intake for you. For most healthy people, 1200 mg of calcium daily from diet and supplements and 800-2000 IU of vitamin D is the target.
to see if menopause hormone therapy is right for you. Menopause hormone therapy improves bone density and has shown a reduction in fracture risk in women at increased risk of osteoporosis or fracture.
about screening tests of bone health and osteoporosis. Screening before a fracture occurs will uncover low bone mineral density in time for treatment.
If you are at risk of osteoporosis, speak to your primary care provider about osteoporosis medications, fracture risk assessment, and referral to an osteoporosis clinic.
Osteoporosis and Mental Health
Bone loss and a diagnosis of osteoporosis can lead to disfigurement, lowered self-esteem, reduced self-image, reduction or loss of mobility, and decreased independence. It may also lead to feelings of depression if you feel you can’t participate in the activities you used to enjoy or if you have lost your independence. Individuals diagnosed with osteoporosis—before or after a fracture—may have feelings of anxiety, due to a fear of falling or breaking a bone. Speak to your primary care provider or reach out to your EFAP provider for support.
References
Gunter J (2021) The Menopause Manifesto: Own your health with facts and feminism. Toronto: Random House Canada
Menopause Foundation of Canada
Stutman L (reviewer) Fall prevention: Balance and strength exercises for older adults. Johns Hopkins Medicine.