The Journal of Clinical Endocrinology & Metabolism Vol. 91, No. 3 0
Copyright © 2006 by The Endocrine Society
Patient Information Page from The Hormone Foundation |
Menopause and Bone Loss
Steven T. Harris, MD,
Robert B. Jaffe, MD and
Dolores Shoback, MD
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How are bone loss and menopause related?
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Throughout life your body keeps a balance between the loss of bone and the creation of new bone. You reach your highest bone mass at about age 30. Then, sometime between age 30 and 35, your body begins to lose bone faster than it can be replaced.
Menopause-the time when menstrual periods end, which usually happens around age 51-dramatically speeds up bone loss. After menopause your ovaries stop producing the hormone estrogen, which helps to keep your bones strong. Even during perimenopause (the period of 2 to 8 years before menopause), when your periods start to become irregular, your estrogen levels may start to drop off.
Over time, too much bone loss can first cause osteopenia (low bone mass) and then osteoporosis, a condition in which bones become weak and are more likely to break (fracture).
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Who is at risk for bone loss ?
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It is important to take care of your bones early in life. As a woman, your risk of bone loss is higher if you have a family history of osteopenia or osteoporosis, or if you are: - White or Asian
- Thin or have a small frame
- Taking steroid medications (e.g., prednisone, cortisone)
- Eating a diet low in calcium and vitamin D
- Getting little or no exercise
- Smoking cigarettes
- Drinking too much alcohol
If you are skipping menstrual periods, or have had both ovaries surgically removed (oophorectomy), or are postmenopausal (the time after menopause; especially past the age of 65), you are also at risk for bone loss.
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How do you know if you have bone loss?
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To measure the strength of your bones, your doctor may do a bone density test (DXA scan). This test gives exact measurements of the density (or thickness) of the bone in the spine, hip and sometimes forearm.
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Recommendations for Testing for Bone Density
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- All women age 65 or older (even if you don’t have risk factors)
- All postmenopausal women under age 65 who have one or more risk factors (other than being white and Asian, and postmenopausal)
- All postmenopausal women with fractures
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How do you minimize and treat bone loss?
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Diet and lifestyle are important to help prevent and treat bone loss. Successful treatment of osteoporosis, however, usually involves a combination of supplements, lifestyle changes, and medication. - Calcium. All women beginning at about 30 or 35 should start taking 1,200 mg of calcium each day. At age 50 (when menopause typically begins), women should take 1,200 to 1,500 mg of calcium each day. To get enough calcium, you should eat a well-balanced diet, including dairy products rich in calcium, and take a daily calcium supplement.
- Vitamin D. Your body needs vitamin D to absorb calcium and incorporate it into bone. Sunlight produces vitamin D in the skin, but the main sources are milk and cereals enriched with vitamin D, egg yolks, salt-water fish, and liver. Some calcium supplements and most multivitamin tablets contain vitamin D. Your daily intake of vitamin D should be 400 to 800 IU per day depending on your age. Adults 65 years and older need 800 IU daily.
- Exercise. Bones remain stronger if they are used in daily weight-bearing activities such as walking or lifting weights. Lack of exercise increases the speed of bone loss after menopause. At least 20 minutes a day of exercise can reduce bone loss.
- Medications. Several medications can help prevent or even reverse osteoporosis by increasing bone density. These medications can be used in addition to calcium, vitamin D supplements and exercise:
- Bisphosphonates (alendronate, risedronate and ibandronate)
- Raloxifene
- Hormone therapy (estrogen only or, if you have a uterus, combined estrogen plus progestin) in selected women and for short intervals.
- Human parathyroid hormone (teriparatide) used to treat severe osteoporosis
- Calcitonin
All of these medications are effective, but they may have side effects. Your doctor will work with you to determine the best treatment option for you.
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What should you do with this information?
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Bone loss is a natural part of menopause, but you can help keep your bones strong. A healthy lifestyle is a great way to start. The sooner you take steps to prevent bone loss, the lower your risk of osteoporosis later in life. And if you already have risk factors for bone loss, have your bone density tested.
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Resources
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- Find-an-Endocrinologist: www.hormone.org or call 1-800-HORMONE (1-800-467-6663)
- National Osteoporosis Foundation: www.nof.org
- Osteoporosis and Related Bone Diseases Resource Center (NIH): http://www.osteo.org or call 1-800-624-BONE
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