Menopause and osteoporosis go hand in hand in the minds of many women — and unfortunately, many conventional healthcare practitioners too. But while menopause is a something we all go through, you should know that excessive bone loss isn’t.
Why you lose bone in menopause
Hormonal changes during menopause disrupt your body’s natural bone building process. Experts used to believe declining estrogen was the single “culprit” when it came to menopausal bone loss. After all, estrogen helps preserve calcium in the body and prevent bone breakdown. Recent thinking, however, recognizes that more is at play than just estrogen alone. As noted researcher Dr. Jerilynn Prior and many other experts now understand, the low progesterone levels common in perimenopause may also affect bone-building cells, disrupting the natural process of bone breakdown and repair. Interfering with this process can have a chilling effect on the health of your bones over time.
On average, a woman loses 10% of her bone mass during the menopause transition — an entirely normal part of the bone breakdown and build up process. After we reach our peak bone mass at age 30, we naturally experience more breaking down than building up. While most women have enough bone mass to handle this loss just fine, added risk factors like poor diet, family history and lifestyle can lead to excessive bone loss of up to 20%.
Recently, we’ve more accurately pinpointed the timing of menopausal bone loss. After looking at a 10-year timeframe around menopause, researchers found most bone loss occurred during one year before and two years after a woman’s last period. These three years are an important window of time for bone protection that you need to take advantage of.
You can reduce extra risk factors for bone loss in menopause
You can do a lot to preserve your bone density — and even increase it — in the years leading up to menopause and following it just by taking control of your risk factors. Since you don’t know exactly when your last period will take place, it’s best to get started now.
Your nutrient needs change in menopause. When estrogen levels decline, vitamin K function in bones also declines, including its role in the proper formation of bone protein which provides the framework for our bones. Most of us don’t get enough vitamin K, especially the most bone-supporting form, vitamin K2 as MK-7. Vitamin K2 MK-7 is found in aged cheeses and fermented foods, including the Japanese dish natto (fermented soy beans). Dark leafy vegetables such as kale, collards or spinach contain vitamin K1. For many, it’s so hard to get enough vitamin K through diet that supplementation is required.
Unfortunately, most of us are also chronically deficient in vitamin D, which your body needs to absorb calcium and limits bone breakdown. I recommend every woman have her vitamin D level tested at least yearly — it’s not very costly. Sun exposure boosts vitamin D production in the skin, but you may need supplements to reach the optimal blood levels of 50–60 ng/mL. The vitamin best D3 form is cholecalciferol.
Lose weight without losing bone.Weight gain — especially around the middle — can be a big problem for women in menopause. But certain weight loss efforts can harm bone. While we’re still analyzing the connection, I think that calorie restriction prevents women from getting enough nutrients in general. Weight loss trends such as eating diets high in animal protein and/or fat can also lead to a loss of calcium in the urine. If you’re going to lose weight, do so slowly (1-2 pounds a week) and include some form of weight-bearing exercise in the mix to foster bone strength.
Reduce physical and emotional stress. Our bodies are under enormous physical and emotional stress during hormonal transitions such as puberty and menopause. Stress causes us to release higher levels of the fight-or-flight hormone cortisol, which can lead to increased programmed cell death in bone-building cells. Over the years, excessive cortisol can weaken our bones. Because our bodies are particularly stressed during the menopausal transition, it’s critical to make time for stress reduction in our busy lives.
Manage hormonal fluctuations. Extreme hormonal fluctuations are not only bone-damaging, but they can also cause difficult menopause symptoms such as hot flashes, irritability and low energy. Many of the steps above will also help reduce extreme hormonal fluctuations. And, we’ve found that herbal remedies, including ashwagandha, red clover and wild yam are effective in restoring hormonal balance and reducing symptoms.
Remember that no matter what stage of life you are in, it is possible to improve your bone health naturally. The most effective approach is to give your body the support it needs to take care of itself and continue to build bone — just as Nature intended.
I’m Dr. Susan Brown. I am a nutritionist, medical anthropologist, writer, and speaker. Get my free weekly newsletter here.