May is Osteoporosis Awareness Month

Let’s talk about something we don’t talk about enough: osteoporosis — especially during and after menopause. Many women do not realize that it is never too early to start preparing your body for menopause, and that the choices made in their twenties and thirties can impact their future health. But don’t worry if you have waited until menopause has arrived to begin to pay closer attention to your health, because there are still things that you can do to help support your body.

First, let’s talk about what osteoporosis is

Osteoporosis literally means “porous bone.” It’s a condition where bones become weaker and more fragile, making them more likely to break — even with something simple like a small fall or even just sneezing. It’s often called a "silent disease" because many women don't know they have it until they experience a fracture.

Why Does Menopause Matter?

When estrogen levels drop during menopause, bone loss speeds up — and for some women, it happens pretty rapidly. Estrogen is one of the body’s protectors of bone density. Without it, bones lose calcium faster than we can rebuild it. In fact, women can lose up to 20% of their bone mass in the first 5–7 years after menopause!
Estrogen levels begin to decrease before you even enter into perimenopause, which is the period of time bridging to menopause. Menopause occurs when a woman has not had a period for 12 consecutive months and marks the end of fertility, and transition into the next phase of womanhood. Medical menopause can occur as a result of surgical or medications as well and unlike natural menopause, it can be an abrupt change for women.

Now, before you start thinking about the dread of menopause, I want you to consider a different outlook. Unfortunately, there is so much negative talk about menopause, and we forget to acknowledge that this is a normal part of the female lifespan. We hear about the nuances and negative symptoms that some experience and become discouraged thinking about this transition. The menopause transition does not have to be negative, and there are things you can do to help your body prepare and that goes for your bone health to minimize the risk of osteoporosis as well.

Osteoporosis Risk Factors

While menopause itself increases risk, it is not the only factor and should not bear the burden of blame. These other factors play a role and some of them are things that we can control:

Family history of osteoporosis or fractures. Genetics plays a role and it is important that you have these conversations with the women in your family to find out if they have experienced these concerns. It is known that caucasian and asian women have a higher risk of osteoporosis.

Low body weight and lower body mass index (BMI) can increase risk of osteoporosis. Some of this may be due to the fact that women with a BMI less than 18 can have nutritional deficits resulting in metabolic based concerns and impact various systems in their body including muscles and bones.

Inadequate nutrition directly contributes to the lack of bone health. Your bones, like many systems of the body, are depending upon nutrition to properly function and maintain. Without adequate nutrition, your bones cannot repair and sustain proper function. This can be accelerated as estrogen levels begin to decrease. Sometimes the answer is supplements or specific nutrients, but these do not replace a well-balanced diet.

Smoking has numerous detrimental effects on the body and it goes much deeper than just impacting your lungs. Smoking results in the body being exposed to various toxins that impact the metabolic processes of the body to inhibit healing, increase inflammation, and decrease calcium absorption.

Excessive alcohol use can interrupt nutrient absorption including calcium, vitamin D, and magnesium, which are all needed for healthy bones. Alcohol consumption may also lead to increased bone resorption, which will pull calcium out of your bones. This can over time result in weaker bones.

Sedentary lifestyle and decreased level of activities does not preserve your joints. It actually can make your bones and joints weaker. In order for bones to remain healthy, they need to be placed under a certain amount of stress. This stress being weight bearing activities and activities that allow for the muscles to pull on your bones. These types of activities can help to increase osteoblast production, which help to build bones. Limiting these activities results in weaker bones simply because of the lack of mechanical stress and chemical factors that respond to this mechanical stress.

Certain medications can increase your risk of having weaker bones and lead to osteoporosis. Two of the most common types of medications that I see my patient’s taking that fall into this category include corticosteroids and a class of hormonal based medications known as gonadrotropin releasing hormones, which are used in conditions such as fibroids or endometriosis. Long-term use of these types of medications are linked to structural changes in bones. It is always wise to ask your prescribing provider and pharmacist about medication side effects that include both short and long-term impact.

Medical conditions like thyroid disorders, celiac disease, or rheumatoid arthritis can also result in osteoporosis due to disruption of normal processes. Because of the complexity of these diagnosis, it is best to speak with your provider if you have any of these disorders to best monitor your bone health, and overall health.

How Osteoporosis Is Diagnosed

Typically, osteoporosis is diagnosed with a DEXA scan (Dual-Energy X-ray Absorptiometry).

This simple, non-invasive scan measures your bone mineral density (BMD). Your results come with a number called a T-score. Here are the ranges used to determine BMD.

Normal: -1.0 and above
Osteopenia (low bone mass): between -1.0 and -2.5
Osteoporosis: -2.5 and below

It's usually recommended that women around menopause (especially if they have risk factors) talk to their doctors about when to start screening. Also, if there is a history of numerous stress fractures, then this may indicate the need to have a DEXA scan prior to the menopausal age.

How can physical therapy help?

This is where the knowledge base of physical therapists is clutch! Physical therapists can help to decrease progression of osteoporosis, assist with prevention, and help to improve bone density.

Here’s how we approach it:

Weight-bearing exercises: Think walking, dancing, hiking — activities that make your bones work against gravity. I purposely did not mention running because research indicates that the benefit only exists for the beginning of the run. As a runner, I am not going to tell you not to run, but I will let you know that you need to also incorporate strength training to get the full benefit for your bones.

Plyometric Exercise: When was the last time you did any type of jumping activity? If you haven’t done it in a while, it is time to start again. Plyometric activities allow for the bones to undergo stress and for the muscles to pull on the bones as well. This stress can promote bone growth and improve the health of bones.

Resistance training: Using weights or resistance bands to build muscle and stimulate bone growth. I like resistance bands because they are easy to transport and take with you, but I also like weights because they can offer a different challenge. Don’t shy away from weights because heavy lifting is supported for bone and muscle health. Plus, if you are carrying all of the groceries or a laundry basket, then it is good training to keep up with your normal routine.

Balance training: Improving and maintaining balance can help to decrease risk of falling and keep you active. It will also help to maintain motion at your joints. With improved balance, the risk of falling decreases which means the risk of fracture also is less. Individuals with osteoporosis are at higher risk for fractures, so this is a step that should not be skipped.

Working with a physical therapist can tailor programs based on your unique history, needs, and fitness level.

Prevention Is the Best Medicine

If you’re approaching or already in menopause, now’s the perfect time to invest in your bone health.

Here are some basics:

Move daily: Aim for at least 30 minutes of weight-bearing exercise most days. The general recommendation according to the CDC and WHO is for at least 150 minutes of moderate intensity exercise per week.

Strength train: 2–3 sessions per week focused on major muscle groups.

Nutrition is important. Get enough calcium, vitamin D, magnesium, and phosphorus. I know that a lot of people are decreasing carbohydrates in their diet, but this is not the best choice for a lot of people. If you are an endurance athlete, please consider that eliminating this macronutrient can directly impact your bone health.

Quit smoking and limit alcohol: Both speed up bone loss. We already talked about how these 2 factors can result in a decrease in bone density.
Final Thoughts

Bone health isn’t just a “someday” issue — it’s a right now investment. What you do earlier on, will directly impact you later in life, and it is important to consider this as you make lifestyle decisions.

Unfortunately, menopause is often associated with a negative connotation, but it does not have to be that way. You can transition well and maintain strong bones throughout it all. Remember that menopause is a normal transition in the female life cycle, so let’s prepare our bodies now to transition well.

You have more power over your bones than you think. Let’s get moving — and nourishing!

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