How does menopause change bone structure?

Dr. Jeanne Morrison, PhD
Family Practitioner

Menopause speeds up the normal process of bone loss and reduces bone mineral density, which makes your bones thinner and weaker. In the years before menopause (perimenopause), a woman slowly loses bone mass. In the two or three years leading up to menopause and for several years after, bone loss occurs more quickly because the body is producing less and less estrogen.

After menopause, women lose bone tissue more rapidly for approximately 4 to 8 years. This more rapid bone loss is because the ovaries stop producing the female hormone estrogen. Estrogen is directly related to bone health. With the elimination of estrogen, bone loss in women after menopause increases.

Each year in the first three to five years after menopause, a woman loses 3 percent to 5 percent of bone mass. So if you're a small, thin Caucasian woman who walked into menopause with not-very-good bones, in five years you'll have lost 25 percent of your bone mass due to osteoporosis. Did menopause cause the osteoporosis? No. It's because of your genetics and lifestyle. But menopause can impact your bone health.

Until the age of 30, bones form more quickly than they deteriorate, but by the age of 35, bone loss begins to outpace bone formation. Lower levels of sex hormones, such as estrogen, tend to weaken bones, which is why, from the onset of menopause to the age of 60, women lose an average of 25 percent of their bone mass. The more bone you have at the time of peak bone mass, the better protected you'll be once bone loss begins. As your bones become weaker and more porous, your risk of fractures and osteoporosis goes up.

Menopause generally comes at an age when women have a greater risk for bone loss, and hormonal changes accelerate this risk. Decreases in estrogen during menopause cause rapid remodeling of the bone by stimulating osteoclasts, the cells that break bone down, and slowing down osteoblasts, the cells that build bone. Bone density peaks at age 30, and women who had less bone density prior to menopause, either from genetics or lifestyle and other reasons, will have increased risk for osteoporosis, which may present itself during menopause.

Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

One of the key changes a woman experiences during menopause—marked by a dramatic drop in estrogen production—is bone loss. Estrogen stops bone tissue from breaking down. When levels of this important hormone dry up during menopause, bones begin to lose their density. Between the time a woman enters menopause and age 60, she will lose about 25 percent of her bone mass.

Losing bone mass means one thing: a higher risk for bone fractures. If you have reached menopause, it's never been more important to get regular exercise, such as walking or jogging, which strengthens bone. Talk with your doctor about taking calcium and vitamin D supplements, as well as medications that may protect your bones.

When you hit menopause, your ovaries reduce the production of a hormone, called estrogen. Estrogen has its hand in a huge range of bodily functions (not those ones), including bone health. In young, healthy women, if all is well on the bone front, bone is remodeled daily. This means that bone is built up more than it’s broken down, which makes sense since that’s when you do most of your growing (vertically, that is). But somewhere in your 30s, bone resorption (break down) begins exceeding bone build up.

Now let’s add estrogen into the mix. Before menopause, estrogen preserves bone density by protecting the cells in charge of building up bones. Without estrogen as your bone bodyguard, you end up losing bone. Estrogen’s disappearing act during menopause exacerbates already weakened bones and increases your risk for osteoporosis.

Osteoporosis (the thinning of bones) can result in brittle bones that are more prone to fracture (break). We all reach our peak bone mass around age 35. From that time, our bones start getting thinner. Estrogen helps to maintain bone thickness. During menopause, when the estrogen level starts to drop, the bone loss can increase. Calcium, Vitamin D, exercise and hormone replacement therapy can all help slow bone loss. Medications that slow down or prevent bone loss can also be used.

Debra Fulghum Bruce PhD
Healthcare Specialist

Although the risk of bone fractures increases with age, at menopause, a decline in estrogen speeds up the removal of bone. During the 5 to 10 years after menopause, there is an accelerated bone loss. In fact, women have a 40 percent chance of having a fracture at some time by age 50, and many women have lost a startling 25 percent of their bone density within the first five years after menopause. This may be difficult to comprehend for active women in midlife when we often take good health for granted. However, at this life stage, it is estimated that less than 10 percent of those who have osteoporosis actually know they have it, and this knowledge does not happen until they fracture a bone.

At a clinical meeting of the American College of Obstetricians and Gynecologists, researchers said that in examinations of almost 90,000 women between the ages of 50 and 64, almost one-third had bone mass low enough to put them at a higher risk of fracture. They concluded that doctors need to focus on the problem of low bone mass and fracture in their younger, postmenopausal patients, as well as in older women. In the studies, younger women had an increased risk of fracture if they had low bone mass, had experienced a fracture after age 45, had generally poor health and if their mothers had also experienced bone fractures in old age.

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There is a direct relationship between the lack of estrogen after menopause and the development of osteoporosis. When estrogen levels start to drop so does the body's ability to preserve bone mass. Estrogen plays a role in bone development. The following supplements, combined with a healthy diet, may help prevent the onset of this condition.

Calcium: If you think you need to take a supplement to get enough calcium, check with your doctor first. A study published in June 2012 in the journal Heart suggests that taking calcium supplements may increase risk for heart attacks in some people; however, the study showed that increasing calcium in the diet through food sources did not seem to increase the risk.

Vitamin D3: Your body uses vitamin D3 to absorb calcium. Experts state ideal vitamin D blood levels are above 30 ng/ml. Treatment regimens vary widely, ranging from 600,000 IU of D2 or D3 as a single dose every 3 months. In general, 2,000–4,000 IU daily is considered enough to prevent deficiency and maintain healthy vitamin D stores.

Both men and women lose bone as they grow older. But dropping estrogen levels around the time of menopause also leads to bone loss in women. Estrogen helps to build and maintain bone. After menopause, bone loss speeds up for several years as estrogen levels rapidly decrease. Bone loss can cause bones to weaken. Weak bones can break more easily. When bones weaken a lot, the condition is called osteoporosis.

This answer is based on source information from the National Women's Health Information Center.

Patricia Geraghty, NP
Women's Health

Women's bone mass, even at peak is always less than men's. The gradual loss of bone mass starts around age 30 to 35 years for both genders. When women hit menopause, there is a more rapid loss for 4 to 8 years as they lose the protection of estrogen. Following the rapid drop, gradual loss continues again. That's why women in their 70s and older have so much higher risk for breaking their hips than men do.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.