Menopause means graduation! One year has passed since the last menstrual period—perimenopause is over. Because of the hormonal changes of the first few years after menopause, bone renovation is more rapid and risks for bone loss are greater. Thus we must continue habits that will keep bones healthy for the rest of our lives.
Bone health is influenced by how we live our lives. Below are the many practical things you can do (with the help of your health care provider) to prevent osteoporosis (the problem of weak and fragile bones).
"A" is for "Active"
Bones gain strength through forces they "feel" from muscular work or gravity. Exercise certainly is important to prevent bone loss. Although in general activity can't build much bone after our teen years, bones are probably stronger in those who regularly do some exercise.
Exercise is also good for whole body health. Therefore aim for at least a half-hour of walking daily. Harder, "aerobic-type" exercise will also help the heart.
"B" is for "Brawny"
This doesn't mean muscle-bound! Weight gain, no matter how much we abhor it, is normal in midlife and this gain will usually persist following menopause. Thinner women lose bone more rapidly after menopause. Muscle weight, in particular, is good for bones. Exercise can maintain muscleweight and decrease waistline expansion. Remember that weight loss unless very gradually and with increased activity—causes bone loss.
You also need muscle and regular activity to keep a good balance that is needed to prevent falling.
Calcium is not only the building block for bone but also ensuring high but safe amounts can prevent bone loss. Women after menopause are recommended to have 1200 mg of "elemental" calcium each day. (Be sure to read labels). Each high-calcium food (1-cup [250-ml] milk and other supplemented beverages, ¾ c. yogurt or hunk of cheese) contains 300 mg of calcium. Those with a family history of osteoporosis or low bone density may need more. Food calcium is safe to 1500 or 2000 mg a day. Calcium needs to be spread out. The body cannot use more than about 500 mg at a time. Get calcium with each meal and at bedtime. If four or more high-calcium foods per day are not practical or possible, replace food with supplements, also taken with meals and at bedtime.
Vitamin D is in some foods and can be made in sun- exposed skin. Everyone needs 600 IU a day and more through the dark winter in Canada. Vitamin D is a safe way to prevent bone loss—1000 or 2000 IU a day is appropriate in the years after menopause and it safe to 4,000 IU a day. 1400 IUs can be achieved with a multiple-vitamin and a 1000 IU pill. Vitamin D is stored in fat and can be taken all at once a single time a day.
"E" is for Easy-Going
Does feeling good about your value and your future help bones? Yes! High stress hormones, such as cortisol, cause bone loss. Cortisol levels also increase with hot flushes and night sweats. If nights are chronically interrupted with trouble sleeping, or night sweats and days are troubled by hot flushes, it is a good idea to seek treatment. Learning and practicing relaxation will help. Sharing with friends, preparing for the future and taking care of yourself will also help decrease stress and protect bone health.
Bone balance requires new bone to be formed by osteoblast cells. Osteoblasts work slowly and after growth in young adulthood often do not keep up with normal bone loss. Progesterone, the natural hormone made after ovulation (egg release) stimulates osteoblasts to build bone. Bone formation is decreased after menopause because progesterone levels are lower. If low bone density is already present, daily progesterone treatment may be needed. Progesterone will also effectively treat hot flushes and night sweats and significantly increases sleep.
"G & H" are for "Good Habits"
That means regular meals and sleep, not smoking and drinking no more than 2 caffeine-containing drinks a day (coffee or colas). Cigarettes, in addition to being addicting, cause lower weights and bone loss. Excess caffeine causes calcium loss. Limit alcohol to one drink a day.
"I" is for "Inhibiting Bone Loss"
Bone is renovated by osteoclast cells that remove old bone to make way for new. Osteoclasts work faster than bone-forming osteoblasts—this causes bone loss. With a family history of osteoporosis, or low bone density at the time of menopause, doing "A" through "H" may not be sufficient to prevent osteoporosis. A bisphosphonate medication called etidronate is effective for prevention and safe. It can be taken in the middle of the night for two weeks of every 3-months. Hormonal therapies to prevent bone loss include estrogen (but it is not safe) and nasal calcitonin. If you have broken a bone and have osteoporosis, stronger medicines may be needed.
Dr. Jerilynn C Prior, MD
March 2014.
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