home » blog »

A high rate of premenopausal bone breakdown increases fracture risk

If you’re a woman “of a certain age,” you’ve probably already heard the fairy tale that women’s bones crumble at menopause. I’ve said many times that thin bones don’t have to be weak bones, and women with osteoporosis or osteopenia in midlife won’t necessarily have a high risk of fracture, but it’s still wise to look at your fracture risk factors — including bone loss — and take action. The question is, how would a woman approaching menopause (but not yet past it) find out if she’s losing bone at a rapid pace, which could be a red flag for heightened fracture risk after menopause?

We know from research that the rate of bone breakdown as measured by markers of bone resorption such as the NTx test correlates with rate of bone loss in menopausal women. But are these markers of bone resorption helpful in predicting which perimenopausal women might fracture later in life? A new study from the University of Pittsburgh suggests this might be the case.

Looking at 2,406 premenopausal women over a period of 7.6 years, researcher Dr. Jane Cauley and colleagues found that women who had NTx levels above the median at any of the yearly clinic visits had a statistically significant (55%) increase in fracture risk within the 7.6 years of the study. So a higher-than-average rate of bone breakdown even several years before menopause could well weaken bone. From my work here at the Center for Better Bones, I find it is wise to look at markers of bone resorption well before menopause. As we now know, bone loss begins in the late 20s and early 30s and, given our current lifestyle, accelerated bone breakdown can occur much earlier than commonly recognized.

If you are a woman approaching menopause — or even younger! — and have a family history of osteoporosis or other risk factors, consider taking our Fracture Risk & Bone Health Profile to determine the basis of your osteoporosis risk. Then, look into getting an NTx test to see whether you have higher than the average bone turnover — and if you do, consider taking steps to alkalize your diet, reduce stress, and get bone-building exercise as a way of addressing the concern before it becomes a real problem. (You can look at my article about stopping bone loss in menopause for more ideas.)

An ounce of prevention is worth a pound of cure!

Reference:
Cauley, J, et al. 2010. Bone resorption and fracture across the menopausal transition: The study of women's health across the nation (SWAN). ASBMR Meeting, Toronto, Abstract 1093.

P.S. There’s a very funny Saturday Night Live spoof ad that skewers the drug companies’ fearmongering around menopausal osteoporosis that I hope everyone will watch!

We created the Osteo Blast blog as our forum to express opinions and educate the public about natural means of supporting and improving bone health and overall wellness. As part of this forum, we sometimes discuss medical issues and medications, and their effects on bone health in general. However, we cannot advise readers about specific medical issues in this forum. If you wish to obtain advice from Susan E. Brown, PhD, about your specific bone health and nutritional concerns, please visit our Consultations page. Other specific medical questions should be referred to your healthcare provider.

Comments

February 22. 2011 19:22

I read your article online about the way bisphosphonates work and can be detrimental in the long run.  Are there other classes of osteoporosis drugs that do not work in the same way and don’t pose the same side effects?  …or at least different side affects (and what would those be)?  

Jacqui

February 23. 2011 10:48

@Jacqui, in answer to your question, there are three drugs that are not bisphosphonates that are used for osteoporosis. They are Forteo (teriperatide), Prolia (denosumab), and Evista (raloxifene). For information on Forteo and Prolia, please read Dr. Brown's article on Forteo, www.betterbones.com/osteoporosis/forteo-bonedrug.aspx, and two of her blog posts, one here: www.betterbones.com/blog/post/What-I-really-think-of-bone-drugs.aspx  and the other here:  www.betterbones.com/blog/post/Mysteries-of-bone-breakdown-revealed-the-RANK-RANKL-and-OPG-system.aspx to learn more. Although Dr. Brown hasn't yet written about Evista (raloxifene), this drug is a well-known selective estrogen response modulator that is used both for osteoporosis and breast cancer prevention. Its major adverse effect is an increased risk of blood clots and stroke. A search on "raloxifene side effects" will help you locate more information on its other possible side effects.

While none of these drugs are bisphosphonates, all drugs have side effects, particularly in relation to long-term use. This is why the Surgeon General recommends that they be used only when dietary changes and exercise, and a thorough medical workup, aren't enough to halt bone loss. Most physicians do not follow the Surgeon General's recommendations, however. See Dr. Brown's blog post on this topic here: www.betterbones.com/blog/post/Is-your-doctor-following-the-Surgeon-Generals-advice-about-osteoporosis.aspx

Hope this helps!

Managing Editor

March 7. 2011 18:20

Thanks for the laugh -another case of medical terrorism!
How do you justify the Ntx test with your physician?
I was diagnosed with osteoporosis at age 52 post menopause ,put on fosamax for a year and then taken off with new guidelines showing low risk of fracture. I have since then taken a multivitamin and calcium supplement which brought my levels into the osteopenia range. I am now taking a One a day and focussing on dietary measures such as yogurt,greens etc.
I am vegetarian lacto ovo ok. How do I further alkalize my diet/
I do weight bearing exercise walk and play tennis. My mother has had osteoporosis related fracture of the hip and wrist so need to be cognizant about my risk.
Any recommendations?
Thanks much
Asha

asha bajaj

March 13. 2011 13:42

Dear Asha:
If your doctor is not a bone specialist, she/he probably doesn't know that the urine NTx test is a simple way to assess the rate of bone breakdown. It is particularly helpful to measure the rate of bone breakdown during the menopausal transition because the average woman loses about 9% of her bone during the first few years before and after menopause. You can slow down this loss with proper nutrition and lifestyle.  Given what you say about your supplement program,I doubt that you are receiving all the 20 key nutrients in the right doses. So you might look at our website and look into our Better Bones Builder product which would replace the nutrients are taking.  Also show your doctor the material I have written on the NTx test which will find on this site. Simply use our search box and put in NTx.  the more the Dr. knows, the more likely she/he will be to order the simple urine test. Best wishes, Susan and

Susan E Brown

Add comment





Loading




Recent Posts