Bone Health

Your bones are composed of living tissue that undergoes a continuous cycle of growth, repair, and reduction. The strength of your bones is determined by the amount of bone tissue present. Denser bone tissue results in stronger and healthier bones.

During the menopausal period, bone tissue is lost at a faster rate than it can be regenerated, leading to an overall decrease in bone density and, consequently, weaker bones. This increased weakness makes bones more susceptible to fractures.

The process of bone density loss typically begins in the late thirties, but it accelerates during menopause due to the decline in oestrogen, a hormone crucial for maintaining bone strength. This is why women are more prone to hip, wrist, and vertebral fractures, as well as the development of osteoporosis, a condition characterised by weakened bones, compared to men.

Fortunately, there are several steps you can take to mitigate the effects of bone loss and slow down the weakening process through appropriate exercise and by ensuring you have sufficient levels of calcium, vitamin D, and other essential nutrients in your diet.

Alongside changes in heart health, bone loss is one of the primary health concerns exacerbated by menopause. However, we often overlook our bone health until an accident occurs, resulting in a bone fracture.

One out of every three women over the age of 50 will experience a bone fracture. Certain fractures, such as hip fractures, can have severe consequences for mobility, daily tasks, and overall health. Moreover, once a bone is fractured, the risk of sustaining another fracture within the following year increases.

Understanding the changes that occur in our bones during menopause and knowing how to reduce bone loss through diet, exercise, and, if chosen, Hormone Replacement Therapy (HRT) is essential.

Osteoporosis is a condition diagnosed when significant bone loss has occurred, leading to an increased risk of fractures. It takes years of bone loss to reach the point of osteoporosis. However, most people are unaware of their weakening bones, as there are typically no symptoms until a fracture occurs, prompting an X-ray or scan for diagnosis.

The risk of developing osteoporosis is higher if you have a family history of the condition, smoke, consume alcohol beyond recommended limits, take certain medications like steroids, have certain medical conditions such as rheumatoid arthritis, or are in the menopausal or postmenopausal stage without using HRT.

If you suspect you are at risk of developing osteoporosis, you can consult your healthcare provider for a FRAX or Q-Fracture assessment, which assesses your individual risk level. You may also undergo blood test or a scan called DEXA (or DXA) to evaluate your bone quality.

In post/menopausal women, the treatment for osteoporosis often includes dietary and lifestyle adjustments, as well as HRT to replenish oestrogen levels and slow down bone weakening. HRT is also considered as a preventive measure against osteoporosis in women under 60 who are at higher risk. For those with established osteoporosis, other medications known as bisphosphonates are typically prescribed.

How do female hormones impact bone health and joints?

Oestrogen plays a crucial role in maintaining bone density. It helps regulate the balance between bone formation and resorption, contributing to overall bone health. It may influence joint lubrication and reduce inflammation, promoting joint comfort and mobility.

While progesterone’s primary role is in the reproductive system, it may have indirect effects on bone remodelling, contributing to overall bone health.

Testosterone, though present in smaller amounts in women, contributes to the maintenance of bone density and strength. It plays a role in supporting overall bone health.

How to maintain strong and healthy bones....

The good news is that you can significantly enhance the strength and health of your bones by following these four strategies in conjunction. 

Supplementing your oestrogen levels can slow down the bone-weakening process. HRT is equally effective in reducing bone loss as other osteoporosis medications. If diagnosed with osteoporosis, a DEXA scan can measure your bone density and monitor changes once oestrogen treatment commences to ensure you are receiving an adequate dose that your body absorbs effectively for long-term bone health.

In addition to adopting the principles of a Mediterranean diet, increase your intake of calcium-rich foods such as cheese, yogurt, milk, as well as green leafy vegetables, nuts, seeds, dried fruits, and the soft bones in canned fish. If you exclude dairy from your diet, consider a calcium supplement if your dietary intake falls below the recommended levels (700-1200mg daily). Read more about Eating Well here. 

While aerobic exercises are beneficial for overall health and fitness, it is essential to incorporate weight-bearing activities that exert pressure on the joints, strengthening muscles and bones. Examples include walking, climbing stairs, jumping, dancing, jogging, and racket sports. Muscle-strengthening exercises that involve resistance, such as weightlifting or resistance band workouts, should be performed 2-3 days a week for 20-30 minutes on non-consecutive days. Activities like yoga, Pilates, and tai chi, focusing on balance and flexibility, can also aid bone health.

Smoking inhibits bone-building cells in the body, increasing the risk of hip fractures as you age. Quitting smoking gradually reduces this risk over time. Excessive alcohol consumption—exceeding 14 units per week—hinders bone tissue growth and raises the risk of osteoporosis. It can also make you unsteady on your feet in the short term, increasing the likelihood of falls and fractures.

By following these strategies, you can enhance the strength and health of your bones and reduce the risk of osteoporosis and fractures.

What are the benefits of Hormone Replacement Therapy on Bone Health & Joints?

The benefits of HRT on bone joints are individualised, and responses may vary based on factors such as genetics, overall health, and lifestyle. The decision to use HRT for bone health should be made in consultation with a healthcare professional. They can assess individual health histories, discuss potential risks and benefits, and tailor the treatment plan accordingly.

HRT, especially with oestrogen, helps preserve bone density and reduces the risk of osteoporosis, a condition characterized by weakened and porous bones.

Oestrogen in HRT may contribute to joint comfort and improved lubrication, potentially reducing symptoms of joint stiffness and discomfort.

HRT may play a role in reducing the risk of osteoarthritis, a degenerative joint condition, by supporting joint structures and function.

HRT, by providing a balance of oestrogen and, in some cases, progesterone and testosterone, supports healthy bone remodelling processes.

HRT, by supporting bone density and joint health, contributes to overall musculoskeletal support, helping maintain mobility and reducing the risk of fractures and joint-related issues.