Integrative Approach to Bone Health in Menopause

Integrative Approach to Bone Health in Menopause

When you think of bone health, you probably think of calcium. But the health of your bones goes beyond drinking milk and becomes of critical importance after menopause when bone-protective hormones are at an all-time low.

Additionally, caring for your bones isn’t just for older adults. By caring for your bones today – no matter your age – you lay the foundation of strong bones for a lifetime.

Today’s article will walk you through bone physiology, osteoporosis, menopausal hormone changes, and, importantly, the critical nutrition and lifestyle habits you can implement today. We’ll even cover bioidentical hormone replacement therapy as a tool for osteoporosis prevention.

Keep reading as we explore:

• Bone basics
• Osteoporosis
• Bone changes in perimenopause and menopause
• Integrative approaches for strong, healthy bones

Bone Physiology

Your bones are alive! Bones are dynamic tissues that constantly break down and build back up as old bone is replaced by new, strong bone (called bone remodeling).

Bones are made of:

• Protein, including collagen and glycoproteins
• Inorganic minerals, including calcium and phosphorus, which account for 50 to 70% of bone mass
• Osteocytes – bone cells that regulate bone homeostasis (balance)
• Osteoblasts – cells that promote bone growth (formation)
• Osteoclasts – cells that promote bone breakdown (resorption)

Bone remodeling begins in infancy and continues throughout life. It’s regulated by hormones, cytokines (chemical messengers), and the bone cells mentioned above. Bone mass peaks in the 20s and 30s and then declines in the 40s and beyond. For women, bone loss accelerates with menopause.

Osteoporosis

What can go wrong with bones? We’ll cover osteoporosis and fracture risk, but there are a couple of other terms worth knowing, too.

Osteomalacia is bone softening due to vitamin D deficiency. Vitamin D plays many essential roles in the body, including promoting calcium absorption in the small intestine.

Osteopenia is low bone density, a precursor or warning sign for osteoporosis.

Osteoporosis is a progressive weakening of the bones characterized by:

• Decreased bone mass
• Decreased bone density
• Decreased bone quality
• Decreased bone strength
• Increased risk of bone fracture (break)

Osteoporosis is silent, often without symptoms, until someone falls and breaks a bone. Most women aren’t screened for osteoporosis until age 65, which usually fails to catch declining bone density early enough.

Estrogen deficiency in menopause is a leading cause of osteoporosis in women. Postmenopausal osteoporosis describes the rapid bone loss after menopause, the one-year mark without a menstrual cycle.

All postmenopausal women are at risk for osteoporosis, and 1 in 3 women will have a fracture related to osteoporosis after age 50. We’ll discuss the connection between estrogen and bone health shortly.

Other causes of osteoporosis include:

• Small body frame/low body weight (BMI under 20); a larger body size is protective
• Alcohol use (2 or more drinks per day)
• Smoking
• Poor nutrition, inflammatory diet
• Sedentary behavior, lack of exercise
• Certain cancer treatments
• Use of certain medications, including glucocorticoids
• Early or surgical menopause
• Bariatric surgery

Menopausal Hormones and Bone Health

Bone tissues have estrogen receptors, and estrogen promotes bone density and health. In perimenopause, estrogen levels begin to decline and bone loss increases with the greatest acceleration post-menopause.

Low estrogen levels or estrogen-deficiency affects bone health in several ways, including:

• Changes in estrogen receptors
• Increase osteoclasts (the cells that break down bone)
• Decreases osteoblasts (the cells that form bones)
• Influences parathyroid hormone, which regulates calcium levels in the blood and bones
• Changes the immune response, shifting towards increased inflammation
• Changes the gut microbiome, affecting bone nutrients

Essentially, the decline in estrogen levels associated with midlife creates an imbalance between bone resorption and formation. Bone breaks down but is inadequately replaced, leading to a decline in bone density and strength and an increased risk for osteoporosis and fractures.

Bone fractures are easily treated in younger people but can be catastrophic as you age and your body is less able to heal effectively. Hip fracture in older adults increases the risk of mortality.

Integrative Approaches to Support Bone Health

As a woman, going through menopause is inevitable, but osteoporosis is not. Good lifestyle choices and early interventions can help prevent bone loss and diseases of frailty associated with post-menopause.

Here are some integrative approaches we use with our patients at TārāMD that we can help you personalize to your individual needs:

Testing

Dual-energy X-ray absorptiometry (DEXA) is the gold-standard assessment for bone density and provides a fracture risk calculation. While the test has some limitations, it is helpful, especially when used early.

Most women aren’t offered a DEXA scan, and insurance often doesn’t cover it until age 65. Still, an earlier baseline assessment is very helpful in catching bone loss earlier, when you have more prevention and treatment options. We can help you access a DEXA scan in perimenopause.  

Exercise and Strength Training

Exercise places mechanical force on the bones, which favorably influences bone metabolism toward building new bone. While all exercise is healthful and reduces the risk of osteoporosis, strength training, specifically, helps to improve bone density. Whole-body vibration (such as using a vibration plate) and mind-body exercises like yoga and tai chi are also beneficial.

Osteoporosis correlates with sarcopenia (age-related muscle loss) and improving muscle strength helps to strengthen the bones. Additionally, exercise helps with balance and mobility, all of which help to prevent falls that lead to fractures.

Read more about exercise in perimenopause and menopause here.

Nutrition

What you eat provides the building blocks for your bones. Beyond choosing an anti-inflammatory eating pattern, specific nutrients are essential for healthy bones – and it’s not just about calcium! These nutrients and food sources include:

• Protein – quality meat, tofu, tempeh, fish, dairy, eggs, beans, nuts, seeds, gelatin
• Calcium – dairy products, almonds, tahini, leafy greens, bone broth/mineral broth, seaweed, legumes, salmon and sardines (with bones)
• Vitamin D – fatty fish (herring, salmon, mackerel, etc.), egg yolks, yogurt, cheese, vitamin D supplements
• Vitamin K2 – fermented/cultured foods, supplements
• Vitamin C – broccoli, bell peppers, strawberries, kiwi, citrus fruits
• Magnesium – leafy greens, avocados, beans, lentils, cacao
• Silicon – whole grains, carrots, green beans
• Boron – prunes, raisins, dried apricots, avocados
• Copper – cacao, quality meat, seafood, nuts
• Zinc – quality meat, shellfish, pumpkin seeds, dairy products, beans
• Manganese – whole grains, shellfish, tea, cinnamon, nuts, whole grains
• Inositol – cantaloupe, grapefruit, oranges, prunes

Herbs and Supplements

Osteoporosis prevention and bone optimization require a personalized approach based on your dietary patterns and risk factors. The TārāMD team can help you personalize your supplement protocol for your needs. For example, if you eat a calcium-rich diet, more calcium from supplements can be problematic for the cardiovascular system. On the other hand, someone who doesn’t eat much calcium, because of a dairy allergy, for example, might need to supplement a little to optimize their intake. As you can see from the above list, numerous other nutrients should be considered.

Other bone-supportive supplements may include:

• Mineral-rich herbs like nettles, oat straw, and horsetail
• Creatine
• Phytoestrogens
• Resveratrol
• Collagen protein/peptides
• Antioxidants

Hormone Therapy

Menopausal hormone replacement therapy (HRT) offers significant benefits for women’s bones by reducing bone loss after menopause.

One recent study suggests HRT is a “cost-effective therapy in the early post-menopause, especially in symptomatic women at risk for osteoporosis unless contraindicated. [Hormone therapy] prevents all osteoporotic fractures even in low-risk populations.” The authors go on to say that all types of estrogen therapy are beneficial for bones, even low doses. Benefits may continue beyond ten years post-menopause.

At TārāMD, we can help you weigh the benefits and risks of hormone therapy based on your health history and goals, understanding that a major benefit is bone health. We always personalize hormone therapy and offer bioidentical (body-identical) options. The lowest-risk bioidentical estrogens are with a transdermal delivery system, such as a patch or gel.

Effective bone care requires an integrative approach that includes personalized nutrition, supplement, and lifestyle support. From there we can utilize modern hormone therapy to help prevent or minimize bone loss as you age. There’s no need to wait until after menopause or even age 65 for a bone evaluation, the earlier you start to care for your future bones, the better.

References

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