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Postmenopausal osteoporosis: changing risks and how to manage them

By Jo Lewin


Most women dread the word ‘menopause’. In reality, it affects women in completely different ways, but the most common symptoms include hot flushes, insomnia, anxiety, memory impairment, and fatigue. Long term consequences can include a decline in libido, osteoporosis, heart disease, and even dementia: all of which are linked to changing hormone levels.

Typically, a woman’s ovaries stop releasing eggs in her early 50s, when her menstrual cycle stops. Some women sail through menopause with only the odd hot flush, whilst others struggle with symptoms such as weight gain, and fluctuating emotions. The physiological reason why the body starts changing is largely down to the drop in oestrogen production, which signifies the end of periods. As the ovaries stop manufacturing the hormones oestrogen and progesterone, menopausal symptoms begin.


What is postmenopausal osteoporosis?

Osteoporosis— meaning ‘porous bone’ – results in an increased loss in bone mass and strength. It is asymptomatic (presenting no symptoms at first), and so often remains undiscovered until weakened bones result in painful fractures.


Why does it happen? 

Although we think of our bones as hard and strong, they are made of living tissue. The inner core of our bones are porous, a bit like a sponge. When a bone is weakened by osteoporosis, the holes in the sponge grow larger and more numerous, which impairs the internal structure of the bone. After menopause, this process is exacerbated, and bone breakdown exceeds the rate bone is built up. Additionally, oestrogen is a hormone that protects bone, and levels decrease sharply when women reach menopause. As bones become weaker, the risk of fractures increases. Women with osteoporosis most often break bones in the hip, spine, and wrist.


Risk factors

Some factors put postmenopausal women at greater risk of osteoporosis, including:

  • Gender: women are more likely to get osteoporosis than men. They have smaller bones, and are affected by the change in oestrogen after menopause
  • Age
  • Ethnicity: Caucasian and Asian women are at higher risk than men and other ethnicities
  • Family history

What can I do about it?

Whilst there is no ‘cure’ for osteoporosis, there are ways you can manage your symptoms and take preventative measures to maintain optimum bone health. A great way to do this is through a healthy diet and lifestyle.


Bone health

Women going through menopause should increase their intake of food sources of calcium, magnesium, and vitamins D and K to maintain integrity of the skeleton. In addition, high amounts of phosphorous – found in red meat, processed foods and fizzy drinks – should be avoided. Too much phosphorous in the diet accelerates the loss of minerals such as calcium and magnesium from bone. Reducing sodium, caffeine, and protein from animal products to moderate amounts may also help the body maintain calcium stores. 

Opt for more alkaline foods, such as vegetables, fruits, seeds, nuts and yoghurt, to help prevent calcium reserves being leached from bones. You should also eat foods high in magnesium and boron: minerals which are important for the replacement of bone, and thus help to reduce the risk of osteoporosis. Apples, pears, grapes, dates, raisins, legumes and nuts are good sources of boron.


Eat more phytoestrogens

Phyto, or plant oestrogens found in certain foods are oestrogenic compounds that bind with oestrogen receptor sites in the body’s cells, creating an increased oestrogenic effect in the body.  By acting in a similar way to oestrogen, phytoestrogens may help in balancing hormone levels. You can increase your intake of phytoestrogens by eating more soya milk and soya flour, linseeds, tofu, tempeh and miso, pumpkins seeds, sesame seeds, sunflower seeds, celery, rhubarb and green beans.
 


Exercise

It is important to establish a regular exercise routine. Weight-bearing exercises are best for preventing osteoporosis, plus exercise makes bones and muscles stronger.  Walking, jogging, playing tennis, and dancing are all good weight-bearing exercises. In addition, strength and balance exercises may help you avoid falls, decreasing your chance of breaking a bone. 


Calcium

Getting enough calcium helps to build and keep strong bones. Excellent sources of calcium are milk and dairy products, fish including canned fish with bones like salmon and sardines, dark green leafy vegetables such as kale, collards and broccoli, calcium-fortified orange juice, and breads made with calcium-fortified flour.


Supplements 

Always check with your doctor first if you think you need to take a supplement to get enough calcium. Calcium carbonate and calcium citrate are good forms of calcium supplements, but check you are getting the right amount, as too much calcium can increase your chance of developing kidney problems. Other vitamins and minerals vital for bone health include magnesium, vitamin E, vitamin D, and zinc. Choose a supplement with a combination of these, and they will be in the right proportion for maximum effect.


Vitamin D

Your body uses vitamin D to absorb calcium. Being out in the sun for a total of about 20 minutes every day helps most people’s bodies make enough vitamin D. You can also get vitamin D from eggs, fatty fish like salmon, cereal and milk fortified with vitamin D, as well as from supplements. The recommended daily allowance of vitamin D is 1000 to 2000 IU. 


Limit alcohol consumption, and do not smoke

Smoking causes your body to make less oestrogen, which protects the bones. Too much alcohol can damage your bones.


If you are lactose intolerant

If you are lactose intolerant, or have difficulty digesting milk, you may not be getting enough calcium in your diet. Although most dairy products may be intolerable for you, some yogurt and hard cheeses might be digestible. There are lactose-free dairy products you can buy, and you can eat lactose-free foods high in calcium, such as leafy green vegetables, salmon, and broccoli.

Jo Lewin

From Jo Lewin

Jo is the Community Nutritionist at the Brighton and Hove Food Partnership. She is a registered Associate Nutritionist with the Association for Nutrition.

Article featured supplements from Healthspan


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