Menopause is a normal and natural part of the ageing process, however for many women, it can be a surprising and confusing time of transition. There are many unexpected physical changes to adapt to including hot flashes, night sweats, sleep difficulties and mood swings, as well as a higher risk of developing osteoporosis, meaning weak and brittle bones that are more prone to fractures.
As we age, both men and women become more likely to have weakened bones as we begin to lose bone tissue more quickly than our older bodies can create it.1 However, for women, the hormonal changes that take place during menopause can increase the rate that this happens, to as much as 3% per year, or 10-20% during the menopause period.2,3,4 By the age 70, women experience, on average, a 30–40% loss of bone mass.5 This is why post-menopausal women experience, on average, a much higher rate of fractures: In 2005, women over 50 yrs experienced nearly 1.45 million fractures in the US, while men the same age only experienced 594,000, while the lifetime risk of fracture for a woman aged 60 years is nearly double than that for a man of the same age.6
Despite these sobering statistics, osteoporosis and weakened bones resulting from menopause can be managed through a range of simple lifestyle changes, alongside the use of painless and low-intensity vibration training, to stimulate bone cells, slow down bone loss, improve bone-mineral density, and reduce your risk of falls and fractures. Here we’ll take a closer look at exactly how menopause affects your bones, and what you can do today to care for your bone health.
How Menopause Affects Your Bones
Menopause is defined as the time that marks the permanent end of periods, and fertility, and according to research, most women begin experiencing menopause between the ages of 45 and 55.7 As women enter menopause, certain hormone levels begin to fluctuate and decrease, including oestrogen.
Oestrogen is a hormone that promotes strong bone health at a cellular level, by regulating bone metabolism, or how the body processes the creation and breakdown of your bones. Oestrogen promotes the activity of osteoblasts, which are the cells that make new bone, and prevents old bone cells from breaking down.8 When oestrogen drops sharply during menopause, this means that over time, new bone is created significantly more slowly than your body is losing it, resulting in weaker, thinner bones, and possibly osteoporosis.
Am I At An Increased Risk of Osteoporosis?
Decreased oestrogen levels aren’t the only cause for osteoporosis. Literally translating to “bones with holes”, osteoporosis is a condition that is diagnosed when your bone mineral density, meaning how much calcium and other types of minerals are present in an area of your bone, is significantly reduced – approximately 2.5 standard deviations or more below the average value, according to WHO criteria.9 Simply put, osteoporosis is present when your normally dense and mineral-filled bones lose enough of this mineral ‘filling’ that it leaves them significantly weaker and more vulnerable to fractures.
There is also a condition called osteopenia, often nicknamed ‘pre-osteoporosis’, which means that your bone mineral density has decreased below normal values, but is not yet low enough for you to be formally diagnosed with osteoporosis.10
Along with menopause, other risk factors may make you more likely to develop osteoporosis at a younger age, or may cause it to develop more quickly if it’s already occurring include:11,12,13
- Physical inactivity
- Calcium deficiency from your diet
- Long-term glucocorticoid (steroid) use
- Smoking
- Being underweight with a low BMI
- Inadequate vitamin D intake
- High alcohol intake
- Poor nutrition
- Stress
- Having a close family relative with osteoporosis
- Taking certain medications that are essential in treating other medical conditions including thyroid hormone supplements, certain diabetes medications, anti-coagulants, certain chemotherapy agents, proton pump inhibitors, certain immunosuppressants
- The presence of other diseases including rheumatoid arthritis, cancer, kidney disease and others
If you suspect you’re at risk of developing osteoporosis, it’s worth asking your doctor for a DEXA scan, to measure your bone densitometry and detect early changes in bone density. The earlier that changes are detected, the most likely it is that proactive steps will effectively maintain and preserve your bone health.
Why Am I Experiencing Joint Aches In Menopause?
Experiencing aches or pains in your joints is another common symptom experienced by women in menopause, and it’s due once again to the drop in oestrogen hormones. Oestrogen helps to reduce inflammation, so as these levels decline, inflammation maty increase, causing discomfort and menopause-related arthralgia, or joint pain:
- Arthralgia is experienced by more than half of the women around the time of menopause14
- Studies have found that postmenopausal women experience a significantly higher prevalence of musculoskeletal symptoms than premenopausal women, and that there is a peak in these symptoms in early menopause. The most common joints affected include knees and hand joint swelling, and these continue to increase with age.15
Is Osteoporosis Reversible?
This depends on how technical you want to be, and different medical organisations hold different interpretations of this term. If ‘reversible’ implies restoring the health of a 70-year-old bone to its 30-year-old density, strength and function, then no – osteoporosis is not reversible. However, there are many things you can do to slow bone loss, improve it, and even help strengthen and rebuild bones. So if your definition of reversing osteoporosis means to improve your bone health and stop the process by which you continue to lose bone, then yes, you can achieve stronger, healthier bones, improve your quality of life, and reduce your fracture risk.
What Steps Can I Take Now? Evidence-Based Ways To Improve Bone Health And Reduce Osteoporosis Risk
Whether you’re in the early stages of menopause or postmenopausal, it’s never too late to take proactive steps to protect your bone health. It all comes down to adjusting your modifiable risk factors while proactively taking further actions that support your bone health. This might look like:
- Exercising regularly: while being told to exercise regularly is a common piece of advice that is often not heeded, weight-bearing exercise is proven to be a treatment and prevention method for both postmenopausal and age-associated osteoporosis.16 Incorporating various forms of physical activity into our daily lives is shown to improve muscle function and offset age-related muscle morphology changes.17 To best benefit from the results, the National Osteoporosis Foundation recommends skeletal loading with high and low-impact weight-bearing exercises for at least 30 minutes per day, 5–7 days a week.18
- Improving your diet: while calcium and vitamin D intake are well-know to be necessary for good bone health, research from the Framingham Osteoporosis Study on over 5,000 adult men and women have shown that various other foods and nutrients play an important role in bone health too,19 including vitamin C, carotenoids, folate and B12, vitamin K, potassium, magnesium, fish (three or more servings per week), omega-3 fatty acids, dairy products (whose nutritional benefits go above calcium and vitamin D to include magnesium, zinc, riboflavin and protein), protein, and more. You can read more about this here.
- Avoiding smoking: smoking can decrease Oestrogen levels in women (directly linked to bone health) and inhibit new bone development.20
- Stopping unprescribed steroid use: research has found that taking 5mg or more of corticosteroids every day for three months or more is enough to significantly increase your risk of fractures and poor bone mineral density.21 While some people may need this for medical purposes, it’s a strong warning sign as to why you should avoid steroids for exercise or sports performance, if they’re not prescribed.
- Limiting alcohol intake: alcohol interferes with the absorption of Vitamin D and calcium in the stomach, which can contribute to lowered bone density and an increased risk of osteoporosis.22
- Maintaining a healthy BMI: a BMI of 23.0 to 24.9 kg/m2 is the optimal range for minimising the risk of osteoporosis, and a lower BMI than this is strongly correlated with an increased rate of osteoporosis.23
- Managing stress levels: chronic stress has a strong impact on a range of biological systems within your body on a cellular level, including your hormones, insulin, growth factors, inflammatory responses, mineral absorption and more, and as such, stress has been strongly linked to osteoporosis across many different studies.24
Taking Further Actions To Support And Improve Your Bone Health
Beyond the modifiable risk factors, you can also take proactive steps to support your bone health. There are two primary ways to achieve this:
1. Medications for osteoporosis: There are a range of different medications available for osteoporosis based on your unique circumstances and other medical conditions, and they have varying mechanisms of action. Common brand names include Fosamax, Actonel, Boniva, and Reclast. You may be prescribed an antiresorptive drug that slows the rate that your body breaks down bone, or an anabolic drug that increases bone formation.
- Poor adherence rates: The use of medications for osteoporosis shows promising results in helping reduce the prevalence of fractures, though they pose some notable barriers. Aside from the risk of adverse effects,25,26 meaning they require very carefully prescription, research has found osteoporosis medication to be associated with poor patient adherence,27,28 leading to poor outcomes. A study examining the attitudes and treatment patterns of Australian GP’s in treating osteoporosis found that in over 80% of cases where patients ceased their medication, prescriptions were not being followed up or continued, placing these people at risk of further fractures and suggesting that osteoporosis was undertreated and underdiagnosed.29
2. Low-intensity vibration training: Vibration training can bring success in slowing down postmenopausal bone loss especially in those who might face barriers to regular exercise. It can also enhance physical fitness and increase muscle strength, neuromuscular coordination and balance, reducing the risk of falls, which often result in fractures.30
Low-intensity vibration therapy involves an individual standing on a vibrating platform. Through ground-based vertical accelerations starting at the plantar surface of the feet, the mechanical vibration is transmitted through the weight-bearing muscles and bones.31 Researchers believe that the mechanism through which vibration-training is believed to exert forces on the skeleton, is via activation of the muscles, which results in a greater quality of bone density, as well as activating bone cells to regenerate.32 A number of studies have shown that vibration therapy is beneficial for bone health:
- Low-intensity whole-body vibration (LIV; 30 Hz at 0.3 to 0.4g) has been shown to stimulate meaningful bone benefits in children with clinical conditions, adults with low bone mineral density, osteoporosis, and post-menopausal women33,34,35,36,37,38
- One study showed after 8 months of vibration therapy, bone mineral density at the femoral neck area increased by 4.3% (p = 0.011) compared to the group who performed walking, and balance in the vibration group improved by 29%, while the group which performed walking showed no improvement.39
- In a one‐year, prospective, randomised, double‐blind, and placebo‐ controlled trial, Rubin et al. reported that low-intensity vibration inhibited deterioration of bone in the spine and femur, even in healthy postmenopausal women, as long as device adherence was at least 80%40
- Maximum leg strength and maximum trunk flexion strength significantly increased in those who participated in vibration training, as well as decreasing pain intensity in the large joints in post-menopausal women41,42
- Studies have found that post-menopausal women weighing less than 65kg (who are also at a higher risk of osteoporosis), benefit the most from vibration-training43,44
- Those who have low bone quality indices at the initiation of the intervention showed the greatest response to treatment compared to those with better bone health, with researchers stating that vibration therapy may thus serve as a potential surrogate for exercise.45
- One study of vibration training in non-osteoporotic postmenopausal women showed that this form of mechanical stimulation could not only inhibit bone loss, but also improve measures of bone quality.46
Post-Menopausal Women Are Improving Their Bone Health With Marodyne
No matter your age, life stage, or menopause status, you can start improving your bone health, managing your osteoporosis, and reducing your risk of fractures by utilising these preventative strategies today together with the use of the Marodyne LiV at home. Marodyne is a vibration therapy platform that is simple and easy to use, while being an effective solution for osteoporosis. It can be utilised by all age ranges, all physical abilities, without the need for repeat prescriptions or GP visits, and without strenuous or unmanageable exercise.
Marodyne LiV is available exclusively from Rehacare. To purchase the device, or for any questions please contact Marodyne LiV Australia on 1300 653 522.
[1] https://pubmed.ncbi.nlm.nih.gov/11525451/
[2] https://pubmed.ncbi.nlm.nih.gov/10469291/
[3] https://pubmed.ncbi.nlm.nih.gov/2053573/
[4] https://pubmed.ncbi.nlm.nih.gov/8592956/
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5643776/
[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3111766/
[7] https://www.nia.nih.gov/health/what-menopause
[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424385/
[9] https://josr-online.biomedcentral.com/articles/10.1186/s13018-021-02772-0
[10] https://www.ncbi.nlm.nih.gov/books/NBK499878/
[11] https://www.racgp.org.au/afp/2012/march/osteoporosis-prevention-and-detection
[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6225907/
[13] https://www.osteoporosis.foundation/patients/about-osteoporosis/risk-factors
[14] https://pubmed.ncbi.nlm.nih.gov/20537472/
[15] https://pubmed.ncbi.nlm.nih.gov/23347340/
[16] https://pubmed.ncbi.nlm.nih.gov/30814687/
[17] Rogers, M. A. & Evans, W. J. Changes in skeletal muscle with aging: effects of exercise training. Exerc. Sport Sci. Rev. 21, 65–102 (1993).
[18] https://cdn.nof.org/wp-content/uploads/2016/02/Exercise-for-Your-Bone-Health.pdf
[19] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928581/
[20] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304634/
[21] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919174/
[22] https://pubs.niaaa.nih.gov/publications/arh26-4/292-298.htm
[23] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652649/
[24] https://pubs.niaaa.nih.gov/publications/arh26-4/292-298.htm
[25] https://pubmed.ncbi.nlm.nih.gov/30814687/
[26] Rossouw, J. E. et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 288, 321–333 (2002).
[27] Siris, E. S. et al. Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin. Proc. 81, 1013–1022 (2006).
[28] Cramer, J. A., Gold, D. T., Silverman, S. L. & Lewiecki, E. M. A systematic review of persistence and compliance with bisphosphonates for osteoporosis. Osteoporos. Int. 18, 1023–1031 (2007).
[29] https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-020-01103-2
[30] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440196/
[31] https://pubmed.ncbi.nlm.nih.gov/14652479
[32] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5226820/
[33] https://pubmed.ncbi.nlm.nih.gov/16824816
[34] https://pubmed.ncbi.nlm.nih.gov/15040823
[35] https://pubmed.ncbi.nlm.nih.gov/23011683
[36] https://pubmed.ncbi.nlm.nih.gov/15040821
[37] https://pubmed.ncbi.nlm.nih.gov/16939405
[38] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5226820/
[39] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1693558/
[40] https://pubmed.ncbi.nlm.nih.gov/15040821/
[41] https://pubmed.ncbi.nlm.nih.gov/21990056
[42] https://pubmed.ncbi.nlm.nih.gov/18710630
[43] https://pubmed.ncbi.nlm.nih.gov/15040821
[44] https://pubmed.ncbi.nlm.nih.gov/11493908
[45] https://asbmr.onlinelibrary.wiley.com/doi/full/10.1002/jbmr.4229
[46] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4187165/