Why Bone Health Is Important for Women & What You Can Do to Support It
Recently, I have had a number of women come into my office asking me what they can do for their bones. They have recently received the results of their first bone density test and are surprised to know that they have low bone mass and they want to do something about it. Most of these women have never given a second thought to their bones before this test result, and now they are concerned. The main comment that I get is “I thought I got enough calcium in my diet.”
However, bone health, especially for women, is SO MUCH more than calcium intake!
Why Do We Care About Our Bones and Osteoporosis?
Osteoporosis is a condition where the bones become fragile.
When it comes to bone health, we are ultimately concerned about fragility fractures caused by osteoporosis as these are responsible for increased mortality, morbidity and chronic pain.
Bone health is on a continuum, where Osteoporosis is on one end reflecting the highest risk of fracture, but many women have low bone mass which increases their risk of fracture. Fragility fractures are responsible for up to 80% of all fractures in menopausal women over the age of 50. Despite the high prevalence of fragility fractures related to low bone mass, there is little emphasis put on osteoporosis prevention. In addition, a report released by the Canadian Medical Association in 2010 stated that only 20% of women and 10% of men who have had fractures receive therapies to prevent further fracture.
The Issues with Screening for Osteoporosis
Though bone density is only one variable contributing to fracture risk, an appropriate risk assessment can only be done if a patient goes to see their physician or allied health care practitioner on a yearly basis. If an individual does go for their yearly physical, and actually has the osteoporosis risk assessment performed, high risk individuals can be identified and possibly go for their DEXA scan earlier than the average age of 65; hopefully before they experience bone loss. In addition, recommendations can be made to decrease their risk.
However, many generally healthy adults do not go to see their doctor unless they really have to. Because of this, they often don’t know that they are at risk of osteoporosis, or have osteoporosis until they go for their first scan at 65 for women or 70 for men; when the damage has already been done!
Let’s Talk About What Effects Bone Health in Woman
This is something that we do not have control over, but it is something that we can be aware of when it comes to risk reduction. Bones are constantly remodelling- building up and breaking down. Once a woman reaches her peak bone mass in her mid-twenties, the scale is tipped toward loss. On average Because estrogen is a strong contributor to bone formation, women start to lose bone MUCH faster around the age of menopause.
This accelerated bone loss slows slightly about 2-3 years after final menstrual period, but it is still higher than before menopause and still higher than the rate at which men lose bone as they age.
- Age of Menopause
Earlier menopause means that a woman is spending more of her life with low estrogen levels and therefore more of her life in a bone loss phase. A woman who experiences menopause before the age of 45 has a fracture risk that is 1.5-3 times higher than a woman who experiences menopause around the average age of 50.
- WEIGHT LOSS
Weight is one of the most significant modifiable risk factors for bone health.
This is a BIG one for women because women are CONSTANTLY interested in losing weight. Women with lower BMI are at increased risk of osteoporosis. Excessive dieting, and/or low protein intake will also increase bone loss.
Moderate alcohol intake is associated with bone loss- this is less than you might think. A 2022 meta-analysis showed that 3 standard drinks per day was associated with bone loss. A standard drink is 1 12oz beer, 1 5oz glass of wine, or 1.5oz spirit. As intake increases, risk increases.
Smoking decreases the body’s ability to absorb calcium. It also disrupts hormones like cortisol and estrogen that results in increased bone loss over time, especially post menopause. After menopause, smoking will increase a woman’s risk of fracture by approximately 30% independent of bone mineral density.
Calcium and vitamin D deficiency are risks factors for increased bone loss. It is important to ensure that you have a balanced diet that provides enough calcium and that your Vitamin D levels are tested and you supplement to sufficiency. However, there is too much emphasis on Calcium as a panacea for bone health; it is not. It is important to have enough, but no benefit to over-supplementing with either of these nutrients.
Calcium and vitamin D supplementation can slow bone loss, but not prevent it.
- Lack of Exercise
- There are also medical conditions and medications that can contribute to bone loss, which is why assessment it key.
What Can You Do To Strengthen Your Bones
- Resistance exercise!
Exercise is vital to bone health as bones and muscle respond and strengthen when they are stressed by weight bearing or impact exercises. Exercise can actually improve bone mass, even in individuals who already have low bone density. Exercises such as weight lifting, running, jumping, stair-climbing and dancing all contribute to improved strength and bone mass. In addition, any exercises that improve strength and balance help to prevent falls, therefore further decreasing risk of fracture.
- Maintain a healthy body weight
WOMEN VIEW BODY COMPOSITION IN THE WRONG WAY! Valuing skinny over strong- to their detriment. Weight that is too low, or crash diets that promote the loss of fat and muscle weaken the body, and the bones.
- Quit smoking and limit alcohol consumption
- Nutrition- appropriate intake of calcium, especially through diet, is important for bone building, as listed above. Protein is also important as it is essential for building muscle and bone as well as improving the strength and flexibility of bone.
- Menopause Hormone Therapy- especially for those who enter menopause before the age of 50 or those at high risk of fracture. Estrogen therapy with or without progesterone prevents bone loss in post-menopausal women. This should be used as first line treatment for women at risk of osteoporosis, or as a second line treatment for those with osteoporosis who do not qualify for or tolerate other available osteoporosis medication.
- Be assessed
A fracture risk assessment should be done before you reach the age of 50. If you are determined to be at high risk you should have a bone density test before the average age of 65. Prevention is the most effective strategy for osteoporosis.
Bone health is an important part of your health plan, if you are a woman in your 40’s or 50’s, even if you are not at high risk of osteoporosis. A plan for healthy bones is also a plan that is good for cardiovascular health and improving symptoms of menopause. If you are interested in optimizing your health as you age, book your appointment today and we can set up a strategy that works for your lifestyle.
If you are looking for a tailored approach to your health, follow the link to book your alignment call.
Dr. Lisa Maddalena, ND