Menopause And Osteoporosis

Osteoporosis is more common in women after they have gone through the menopause and this is because bone density decreases as the body's levels of oestrogen fall.

What is osteoporosis?

Osteoporosis is a condition, which causes the bones to become weaker, increasing the risk of injuries caused by falls and accidents. If you have osteoporosis, you will be more likely to suffer fractures and broken bones. Often, osteoporosis is only diagnosed once you have already suffered a broken bone, as there are no clear signs that you've developed it. The most common types of osteoporotic injury include fractured wrists, hips and vertebrae (the bones in the spinal column).

Who gets osteoporosis?

Around 3 million in the UK are believed to have osteoporosis, but there may be many more who have not yet been diagnosed; it is estimated that 1 in 50 women have osteoporosis at the age of 50, but this rises steeply to 1 in 4 by the age of 80 years old. Osteoporosis tends to be more common in women than men and it most commonly develops after the menopause when oestrogen levels decrease. You may also be at risk of developing osteoporosis if you:

  • have had a hysterectomy
  • are aged over 60 years old
  • have family history of weak bones
  • have had or still have an eating disorder
  • are underweight (you have a body mass index of less than 18.5)
  • have calcium or vitamin D deficiency
  • had early menopause (before the age of 45)
  • lead a sedentary lifestyle
  • smoke
  • drink excessively
  • have thyroid disorders or hormone imbalance
  • have taken steroid medication for a prolonged period of time
  • have underlying health conditions, including Crohn's disease, COPD (chronic obstructive pulmonary disorder) or rheumatoid arthritis

Signs of osteoporosis

The most common sign of osteoporosis is an increased risk of fractures and often, this condition is diagnosed following an injury caused by a fall or trip; in people with osteoporosis, the bones are weaker, so even a minor fall can cause the bones to break. Fractures, which would not normally cause the bone to break in a person who does not suffer from osteoporosis, are known as fragility fractures. The implications of injury can also be greater if you have osteoporosis; for example, around half of those who suffer hip fractures require additional support at home because their mobility becomes impaired.

Sometimes, osteoporosis can also result in a change in posture, which is commonly known as a stoop; this makes the spine curve and may cause you to constantly bend, rather than standing up straight. In some cases, you may also shrink slightly. In severe cases, when the position of your spine is curved significantly, this can cause problems with breathing, as the lungs may become compressed.

Diagnosing osteoporosis

The best way to deal with osteoporosis is to prevent it and if you are at risk of developing the disease, you may be advised to have regular bone density scans. If you are at risk, for example you are aged over 50, you have family history of the condition or you have gone through menopause, it is likely that your GP will carry out basic evaluations to see if you require bone tests; if you have a lot of risk factors or you have symptoms, which may suggest that you have osteoporosis, a bone density scan can help to confirm a diagnosis or show early signs, which may then be treated. This scan is known as DEXA (dual-energy X-ray absorptiometry).

Preventing osteoporosis

You can reduce your risk of developing osteoporosis by:

  • exercising on a regular basis and doing light weight work to build up your strength (ideally you should try to work out around 4-5 times per week and it's really beneficial to do weight-bearing exercises)
  • eating a healthy and balanced diet
  • ensuring you hit your recommended daily intake of calcium
  • getting out and about to get your vitamin D intake
  • drinking in moderation
  • giving up smoking (your GP or dentist can help you with this)

Treatment for osteoporosis

There are various treatment options for osteoporosis and the type of treatment you receive will usually depend on your age and the severity of the condition, which will be highlighted by the results of your bone density scan.

Medication: medication is usually the first choice treatment for osteoporosis; the aim is to reduce the risk of fractures and slow down the process of bone loss.

Bisphosphonates are most commonly used and examples include risedronate, alendronate and etidronate. Alendronate is commonly the first choice and other options may be considered if it doesn't suit you. Often, drugs come with specific instructions and it's important to adhere to the dosage instructions to ensure the drug works properly and reduce the risk of side-effects.

It is possible to experience side-effects when you take bisphosphonates and these may include constipation, difficulties with swallowing, heartburn, diarrhoea and very rarely, symptoms that affect the jaw that are linked to osteonecrosis, a serious condition, which damages the bone tissue in the jaw. It is very important that you seek medical advice if you develop symptoms, such as a heavy feeling in your jaw, pain, inflammation, loss of sensation or a wobbly tooth.

Denosumab: this form of medication is often prescribed for post-menopausal women and may serve as an alternative to bisphosphonates when they are not easily tolerated. The drug is administered via an injection, which is given twice a year; it helps to reduce the risk of fractures by preventing bone loss. Like other medications, there is a very low risk of osteonecrosis.

Selective oestrogen receptor modulators, such as Raloxifene: this drug may be prescribed to women who have already suffered fragility injuries, as it helps to slow down the loss of bone tissue, which occurs during the menopause. There is a slight risk of DVT (deep vein thrombosis) and you should seek advice immediately if you develop sudden pain, skin warmth or inflammation in your legs.

Strontium ranelate: this may be recommended when bisphosphonates are not suited to the individual; it helps to reduce bone loss and also to facilitate the creation of new bone cells (known as osteoblasts). Possible side-effects include diarrhoea and sickness; in very rare cases, a severe reaction may occur and you should seek help if you develop irritated skin.

Parathyroid hormone (most commonly teriparatide): parathyroid hormone plays an important role in regulating calcium levels in the body; these treatments are used to encourage the production of new osteoblasts to strengthen bone tissue. Treatment is given in the form of injections.

Dietary supplements: most people get enough calcium and vitamin D from their diets, but if you have osteoporosis, it's likely that you will need a higher intake and supplements may be recommended. If you are thinking of taking supplements, always ask your GP for advice first.

HRT and osteoporosis

HRT (hormone replacement therapy) used to be used to treat osteoporosis in women during and after menopause, but it is not used commonly for this reason any longer. HRT can help to ease symptoms associated with menopause, but there are risks associated with its use and they are generally believed to outweigh the benefits when it comes to treatment for osteoporosis and other forms of treatment are preferred. HRT has been proven to help sustain bone density, but it can also slightly increase the risk of breast cancer, strokes and ovarian cancer and other medications are used today.

Lifestyle choices

Making positive lifestyle choices can also help to alleviate symptoms of osteoporosis and reduce the risk of injuries; these include:

  • exercising and keeping fit, especially doing weight-bearing exercises, such as light weight work in the gym, rowing, cycling or playing tennis; swimming is good for soothing aches and pains, but it doesn't help with osteoporosis, as the water bears your body weight when you swim
  • eating well
  • avoiding smoking and drinking excessively

There are also simple measures you can take to try and prevent falls and slips, such as wearing well-fitted footwear, keeping stairways and corridors clear of obstructions and taking extra care in wet and icy weather conditions.

In some cases, the risk of falls is increased by poor vision, hearing loss or taking certain forms of medication, which make you feel dizzy and unsteady on your feet; regular eye and hearing tests are recommended and you should see your GP if you have side-effects of taking certain types of medicine; it may be possible to switch to a different drug, which doesn't make you feel drowsy.

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