Strategies for Strong Bones at Midlife, Menopause and Beyond

For many people, the first sign of osteoporosis, a debilitating bone disease, is actually breaking their first bone!

That’s because it happens far more often than many of us realize. After working hard to avoid going to a doctor’s offices during COVID over the past year, I’m finally catching up on some preventative health screenings. The other morning I went for a bone density scan and I started thinking…have you had one? Has your doctor ever talked to you about preventing osteoporosis, a common condition that affects 10 million Americans, or 1 out of every 3 women and 1 in 5 men over the age of 50? Well, I am eating a calcium-rich yogurt as I write this and will share some additional dietary strategies for both treating and preventing osteoporosis!

Part 1: Understanding the Concepts and Screening

What is osteoporosis and osteopenia?
Osteoporosis is characterized by low bone mass and loss of bone tissue, which lead to weak and fragile bones. Osteoporosis is called the ‘invisible’ disease, since there are no obvious signs or symptoms until a bone breaks, which can happen after a minor fall from a standing height, a bump, sudden movement, or even from bending or lifting.
Osteoporosis-related fractures are most likely to occur in the hip, spine, wrist, or upper part of the arm, but other bones can break too. One broken bone leads to another, and that’s why it’s important to diagnose and treat the disease as soon as possible.
Osteopenia is considered a precursor to osteoporosis – it’s like the halfway mark between healthy bones and having osteoporosis. We all have the power to take charge of our bone health and prevent the descent into osteoporosis with adequate and early screening and proper treatment. Preventing osteoporosis is much less costly both financially and emotionally! Diet, exercise and sometimes medication can help keep bones strong for years.

Who is at risk of osteoporosis?

Many people think of osteoporosis as an “old lady” disease, but nothing could be further from the truth! Osteoporosis starts much earlier in life. Our bones are at their strongest (called maximal bone density) between the ages of 25 – 30. So, it is important to build strong bones at a young age so that they will remain strong later in life. Having a history of dieting and/or having an eating disorder puts an individual at particularly high risk and has often been overlooked as a contributing factor.
A condition referred to as RED-S, or Relative Energy Deficiency in Sport is now understood to have a significant impact on bone health as well as many other systems in the body. It was previously referred to as the female athlete triad, which by definition is the combination of disordered eating, amenorrhea (loss of menses) and osteoporosis. The consequences of lost bone mineral density are devastating for athletes. In addition to the population of young athletes, there are many other risk factors for osteoporosis.
Certain risk factors for osteoporosis are out of our control. They include:

• Being born female
• Having a direct relative who experienced an osteoporotic fracture
• Race (whites and Asians are more likely to develop the disease)
• Being post-menopausal
• Taking steroids for a long time for asthma, arthritis, or other conditions
• Having an illness that affects the absorption of nutrients such as Crohn’s or Celiac disease
• Having certain diseases such as chronic kidney, liver, and thyroid disease

Other risk factors are within our control, and we can work to make positive lifestyle changes. These modifiable risk factors include:

• Having inadequate dietary calcium
• Having a low blood Vitamin D level
• Dieting with low calorie intake
• Smoking
• Excessive alcohol intake (more than two standard drinks)
• Excessive caffeine intake (greater than 3 cups of coffee per day)
• Excessive intake of colas
• Not exercising

How many people get osteoporosis?

10 million Americans already have osteoporosis and 18 million more have low bone mass, which increases their susceptibility. There are gender differences in its prevalence and this is related to the role of estrogen in maintaining strong bones; post-menopause is a time of rapid bone loss due to low estrogen. Studies report that 1 in 2 women and 1 in 8 men will have an osteoporosis-related fracture in their lives. In fact, in women over 45, osteoporosis accounts for more days spent in the hospital than many other diseases, including diabetes, heart attacks, and breast cancer!

Why does osteoporosis happen?

Osteoporosis results from an imbalance between new bone formation and old bone resorption. Calcium and phosphorous are minerals which are needed for normal bone formation. Calcium is also essential for the heart, brain, and other organs to function properly. So, when dietary calcium is inadequate, the body will reabsorb, or take calcium out of our “bone bank” – which is the skeleton. This makes our bones weaker, resulting in brittle and fragile bones that can break easily.
Early in the course of the disease, osteoporosis causes no symptoms. Later, there may be dull pain in the bones or muscles particularly in the lower back or neck. As osteoporosis progresses, sharp pains may develop suddenly. It may be worsened by activity that puts weight on the area.
If you are past menopause and notice constant pain in areas such as the neck or lower back, consult your doctor for further evaluation including risk assessment and bone density scanning.

Screening and diagnosing osteoporosis

A simple screening tool for osteoporosis is measuring change in height. One study demonstrated that prospective height loss is an effective tool to identify patients with vertebral fractures, low bone mineral density, and vitamin D deficiency although a lack of height loss does not rule out these diagnoses. If significant height loss is present, this supports a further workup.
The most common method for diagnosing osteoporosis is to measure bone density with a DEXA scan (dual-energy absorptiometry scan). You lie down in the machine and it measures the density of your bones, usually at the hip and spine. Results for those post-menopausal are given as a T-score. (Premenopausal values are given as a Z score.)

• “Normal” bone density: T score range of minus 1.0 (-1.0) to 1.0.
• Osteopenia (or low bone mass): T score of -1.1 to -2.4. This means a person has already started to lose bone mass; it’s a precursor to osteoporosis and it’s a good reminder to start strengthening bones immediately!
• Osteoporosis: T score of less than -2.5. Your doctor will help you devise a program that includes medication as well as lifestyle changes.

Sometimes we can diagnose osteoporosis without actual testing. If a fracture is sustained from a non-traumatic event, that’s all the evidence needed. For example, if you fall out of your chair, or fall from standing or even while walking and you fracture a bone, chances are you already have osteoporosis.

Who should be screened when?

The National Osteoporosis Foundation (NOF) recommends the following groups obtain a bone density test: Note: Women includes people with a uterus:

• Women aged 65 or older
• Men aged 70 or older
• People who break a bone after age 50
• Women of menopausal age with risk factors
• Postmenopausal women under age 65 with risk factors
• Men aged 50-69 with risk factors

The NOF recommends the first bone density test by the time you are 65 to establish a baseline, and then every 2 or 3 years after to monitor whether your bones are getting more brittle. This seems a bit late to me and I will explain why:

In my nutrition practice I see many people with long histories of chronic dieting, which is a risk factor for osteoporosis. Considering that the average age of menopause in the US is 51 and that we lose bone mass very rapidly in the first few years’ post menopause, waiting until age 65 might miss a whole group of people who would benefit from screening. If this group were found to have osteopenia or osteoporosis, then more intensive osteoporosis management could start earlier.

Here’s Part 2 in this series, which focuses on dietary changes you can take to maintain strong bones for a lifetime to prevent osteoporosis.
You can also read about Vitamin D and Osteoporosis and how you can add this much needed vitamin (and others) in your diet.
If you are looking for professional support guidance as you navigate your years before and after menopause, why not register for the Intuitive Eating Essentials Online Course? It includes an entire module on Menopause and Intuitive Eating. Get full access – instantly – to a library of Intuitive Eating training videos, handouts, and resources AND two (2) monthly group support calls.

You can get more details here or book a quick call with me to talk over the program and determine if that is the ideal way for you to change your habits and change your life – and lifestyle!