Postmenopausal Osteoporosis

Postmenopausal osteoporosis is a condition where bones become weak and brittle after menopause, affecting millions of women worldwide. Understanding this condition and taking proactive steps can help protect your bone health and reduce the risk of fractures.

Table of contents

• What is postmenopausal osteoporosis?
• The connection between menopause and bone health
• Symptoms and signs
• Risk factors
• How is it diagnosed?
• Treatment options
• Prevention and lifestyle changes

What is postmenopausal osteoporosis?

Postmenopausal osteoporosis is the development of osteoporosis (a condition that makes bones weak and brittle) after a woman goes through menopause. Osteoporosis means “porous bone,” and it occurs when bones lose more mass than what is normal for a person’s age^[1].

This bone loss leads to more brittle bones and a higher risk of fractures. When bones become weak through osteoporosis, even simple actions like bending over, coughing, or a minor fall can cause a bone to break^[3]. The most common fractures occur in the hip, wrist, and spine^[2].

Of the estimated 10 million Americans with osteoporosis, about eight million or 80% are women^[7]. Approximately one in two women over age 50 will break a bone because of osteoporosis^[7]. Research indicates that up to 20% of bone loss can happen during the years around and after menopause^[4].

The connection between menopause and bone health

Postmenopausal osteoporosis is directly related to the decrease in estrogen (a hormone that protects bones) that occurs during menopause^[2]. Estrogen helps prevent bones from getting weaker by slowing the natural breakdown of bone^[2].

As women approach menopause, their reproductive hormones drop. Most women reach menopause between the ages of 45 and 55, with the average age being 51 to 52^[6]. When estrogen levels decrease during and after menopause, bone loss can accelerate significantly^[2].

Bone is living tissue that is constantly being broken down and replaced. When you’re young, new bone is made faster than old bone is broken down. Most people reach peak bone mass around age 30^[3]. After menopause, the body begins to break down old bone faster than it creates new bone, causing a decrease in bone density (the thickness and strength of bones)^[5].

On average, women lose up to 10% of their bone density in the first 5 years after menopause^[6]. Statistics show that one in two postmenopausal women will have osteoporosis, and most will suffer a fracture during their lifetime^[4].

Symptoms and signs

Osteoporosis is often called a “silent disease” because there are typically no symptoms in the early stages of bone loss^[3]. Many people don’t notice any symptoms until a fracture happens^[2].

When symptoms do appear, they may include:

• Back pain caused by a broken or collapsed bone in the spine^[3]
• Loss of height over time^[3]
• A stooped posture or hunching over^[2]
• A curve in the back^[2]
• A bone that breaks much more easily than expected^[3]

Fractures associated with osteoporosis cause pain, decreased mobility, and reduced function. They are also associated with decreased quality of life and increased mortality^[4].

Risk factors

Besides being postmenopausal, several other factors can increase your risk of developing osteoporosis^[2]:

• Family history of osteoporosis
• Thin or small body frame
• Diet low in vitamin D and calcium
• Being underweight
• Sedentary lifestyle (not being physically active)
• Tobacco use
• Early menopause, which can result in lower bone density later in life
• Regularly consuming more than two alcoholic drinks per day
• Long-term use of certain medications such as steroids or Depo-Provera

Women who are white or of Asian descent, especially older women who are past menopause, are at highest risk^[3]. Women tend to have smaller, thinner bones than men, which is one reason why they are more likely to get osteoporosis^[7].

How is it diagnosed?

Bone mineral density (BMD) testing is the most common way doctors evaluate bone health^[2]. Doctors generally recommend that women complete a preventive osteoporosis assessment around age 65^[2]. However, if you’re postmenopausal and concerned about your risk factors or have recently experienced a fracture, your doctor will likely recommend that you go ahead with the bone density screening^[2].

The most common BMD test is called dual energy X-ray absorptiometry (DXA), which is like a low-power X-ray scan^[2]. Usually the lower back, hip, or forearm is scanned. According to the World Health Organization criteria, osteoporosis is defined as a T-score of less than or equal to -2.5, while osteopenia (lower bone density but not yet osteoporosis) is defined as a T-score between -1.0 and -2.5^[5].

The scan can be used to diagnose osteoporosis, estimate bone fracture risk, estimate the rate of bone loss, and monitor the effectiveness of osteoporosis treatment^[2].

Treatment options

Treatment for postmenopausal osteoporosis usually depends on your likelihood of future fractures. If your risk is low, lifestyle changes to manage bone loss and rebuild bone density may be all that your doctor recommends^[2]. Treatment choices are based on severity, rate of advancement, and individual patient-specific characteristics^[1].

In more serious cases, certain medications or therapies may be recommended:

Bisphosphonates are the most commonly prescribed medicines for osteoporosis^[2]. They slow the rate of bone loss, which allows for increases in bone density and decreases in fracture risk. Examples include alendronate, risedronate, ibandronate, and zoledronic acid^[10].

Denosumab is another medication that increases bone density and reduces overall fracture risk^[2]. It is delivered by injections under the skin every six months. If you take denosumab, you might have to do so until your healthcare professional transitions you to another medicine, as research shows there could be a high risk of spinal fractures after stopping it^[14].

Hormone replacement therapy can increase bone density for postmenopausal women. Evidence from randomized controlled trials shows that hormone replacement therapy reduces the risk of spine, hip, and other osteoporotic fractures^[9]. Depending on other health factors, modified estrogen (Raloxifene) may be used^[2].

Other bone-building medications may be recommended if other treatments aren’t effective enough or if your osteoporosis is severe. For example, teriparatide and abaloparatide are two medications that mimic parathyroid hormone (which helps regulate calcium levels in the blood) to trigger new bone growth^[2].

It’s crucial to do follow-up, and patient compliance should be closely observed. Osteoporosis is an incurable chronic condition, like heart disease, diabetes, or hypertension^[8]. The benefit of osteoporosis therapies far outweighs the rare risks^[8].

Prevention and lifestyle changes

Lifestyle changes can help prevent bone loss as well as rebuild bone density and bone strength if you’ve already been diagnosed with osteoporosis. By adopting a healthy lifestyle that includes regular exercise and a balanced diet, you can protect your bones^[1].

Nutrition: Aim to eat about 1,300 mg of calcium every day, which is equal to 3 to 4 servings of dairy such as yogurt^[6]. Other good sources of calcium include firm tofu, almonds, Brazil nuts, dark green leafy vegetables, and fish with edible bones like sardines^[6]. All premenopausal women should be advised to take vitamin D and calcium supplements regardless of whether or not they have any bone defects^[1]. Vitamin D allows your body to absorb calcium and is necessary for building strong, healthy bones^[4].

Exercise: Exercise plays an important role in maintaining bone health. It also improves muscle strength, balance, and fitness, and reduces the risk of falls and fractures^[6]. It’s recommended you do 30 to 40 minutes of physical activity most days of the week. Weight-bearing exercises (like stair walking, skipping, running, tennis, and dancing) and resistance training (like weight machines, dumbbells, push-ups, and squats) support bone health^[6].

Lifestyle changes: Smoking and alcohol consumption should be restricted^[1]. Try to reduce or stop drinking alcohol, drinking coffee, and smoking^[6].

Good lifestyle habits can help you protect your bones and decrease your chance of getting osteoporosis. You are never too young or old to take care of your bones^[7]. The higher your peak bone mass, the more bone you have built up, and the less likely you are to develop osteoporosis as you get older^[3].