Why the menopause may cause osteoporosis
How to protect your bones as you get older
1 in 3 women and 1 in 5 men aged over 50 will break a bone because of osteoporosis. More than 300,000 Britons suffer fractures from minor bumps every year. At best, a broken bone is painful and debilitating. At worst, it can spell the loss of independence. But you can cut your risk.
What does it mean?
Doctors do seem to love long words, but it's not just to make them feel important. Mostly they're a combination of medical terms that link different conditions together. So 'osteo-' is anything to do with bones, and '-porosis' means porous (like porous rocks, that have tiny channels water can get through). So osteoporosis is basically 'thinning' of the bones.
Your bones aren't solid - they're made up of a network of tough connective tissue, called collagen, and minerals (mostly calcium).They're also not static - in fact, they're being broken down and built up all the time. That's why bones heal when you break them. When you're growing, the building up happens faster than the breaking down, and then the two balance each other. But once you're over about 40, bony material starts being reabsorbed faster than it's laid down. As a woman, this process speeds up further once you go through the menopause.
This means your bones become less dense and less strong, making you prone to breaks from minor falls. The older you are, the greater the risk. You could break a hip or a wrist by tripping over from standing height. And the bones in your spine can also collapse with minor trauma, causing severe ongoing pain.
It's never too young to start
Even though most people don't start losing bone density until their 40s, you should be thinking about protecting your bones, whatever your age. Actually, if you're old enough to read this, you should have been protecting them for years! The stronger your bones are in your early 30s, when they're at peak density, the more bone you have to lose without them becoming vulnerable. That's one of the reasons men are less likely than women to suffer an osteoporosis-related fracture - their bones are more dense to start with.
Building healthy bones actually starts before you're born, so pregnant women can give their children a boost in the bone stakes by getting enough calcium and vitamin D in their diets. As for kids, it's important to sneak regular calcium into them even if they're going through a fussy eating phase. Under-2s should have full-fat dairy products, but over-2s can have any variety. Yoghurts, milk, cheese and fromage frais all contribute.
Men vs. Women
Women lose bone quicker than men do, especially after the menopause, so you're more likely to break a bone due to osteoporosis if you're a woman. Two thirds of osteoporosis fractures are in women past the menopause. The female hormone oestrogen offers some protection, so you're at higher risk if you went through the menopause early (under 45) or are underweight because of conditions like the eating disorder anorexia, which lowers your oestrogen.
Osteoporosis often runs in families, so a parent/brother/sister with osteoporosis (or a hip fracture) means your risk is higher too. So does having had a fracture after a minor fall yourself. Having the joint problems rheumatoid arthritis or ankylosing spondylitis, or bowel problems like Crohn's disease (that can affect absorption of vital nutrients) also make you more prone.
Keep your bones happy
If you have a broken bone from a minor fall, or if your doctor thinks you're at risk, they'll refer you for a bone scan. This quick and completely painless procedure is similar to an Xray, usually of your hip and spine. It tells your doctor whether your bones are normal or a bit thin (osteopenia), or whether you have osteoporosis.
If you've broken a bone and have osteoporosis, or if you have other risk factors (including being older), your doctor may recommend regular tablets - usually one called alendronate, taken daily or monthly. These can delay the start, or the progression, of osteoporosis. So can HRT, although this is usually only given around the menopause.
Fortunately, there's lots you can do to protect your bones. Among the most important tips are:
- Keep your alcohol intake down (ideally under two units a day but definitely under four).
- Don't smoke (as if you needed another reason to quit!).
- Exercise regularly. It's weight-bearing exercise that helps strengthen bones and the muscles that support them, so brisk walking, jogging, dancing and lifting small weights are ideal. Swimming and cycling are great for your heart but not your bones.
- Get enough calcium in your diet. Low-fat dairy foods (milk, yoghurt, cheese); tinned fish with bones; soya products (like tofu); spinach, dried figs or apricots; pulses and fortified bread or cereals - these are all good sources.
- Low-fat dairy products are just as high in calcium as their full-fat alternatives, if not higher.
- Get out in the sun for 15-20 minutes a day with face and arms uncovered from April-October to top up your vitamin D.
- Take a vitamin D supplement of 10 micrograms a day in winter, and all year if you're over aged 65 or don't get outside much.
- There's some evidence that getting enough protein in your diet can also protect your bones. Lean chicken or red meat, fish, eggs and dairy products are all good sources.
- There's no need to miss out on protein if you're vegetarian or vegan - opt for tofu, nuts, beans and lentils instead.
With thanks to 'My Weekly' where this article was originally published.