How to keep your bone strong after menopause?

A friend in her early fifties is starting to get back pain. Spinal compression fracture, a tiny crack in the bones at her lower vertebra, might be a possible cause for her, according to her doctor. The primary cause of such compression fracture in post-menopause women is osteoporosis.  The bones are getting brittle.

Low back pain in older women can be due to osteoporosis.

I have explained the physiological changes during menopause in a previous post (See DO YOU REALLY NEED CALCIUM SUPPLEMENTATION DURING MENOPAUSAL AGE?). It is a fact that women may experience bone loss of 2% to 5% per year starting from menopause. Such bone loss may continue for 10 years. One needs to maintain healthy bones during this period to avoid painful fracture.

There are three main causes of poor bone health: Insufficient exercise, poor vitamin D levels, and low dietary calcium [1]. To keep your bone strong, you will need to address these three issues.

Physical Exercise

Physical exercises can be an effective means to stimulate the remodelling of the bones. Our bones are not dead tissues, they are alive and constantly undergoing rebuilding and reshaping. In fact, bone remodelling is a lifelong process. There are two types of bone cells involved in this process, osteoblasts and osteoclasts.  Osteoclasts are bone-resorbing cells which remove the older bone tissues and osteoblasts are bone-forming cells which lay the new bone matrices. The activities of osteoblasts and osteoclasts by hormones as well as by mechanical loading [2]. Exercises assert the mechanical loading to promote the remodelling of bone to increase bone density.

Yoga can be a good exercise to improve bone density.

Two main types of exercises are required: (1) weight-bearing aerobic exercises as well as (2) strength and resistance exercises [2]. Weight-bearing aerobic exercises are activities impacting the arms, feet, and legs are bearing the weight. Walking, stair climbing, jogging, volleyball, tennis and similar sports, Tai Chi, and dancing are examples. Strength and resistance exercises are those with joints moving against resistance, such as weight-lifting, swimming, or cycling.

To improve bone mass density, it is recommended that post-menopause women perform moderate exercises of both aerobic and resistance exercises for two and a half hours each week [3]. So, pick your favourite exercise and start doing it.

Keep to an exercise routine can help to maintain strong bones.

Vitamin D

Vitamin D is needed for the proper absorption of calcium, the main ingredients of bone building, from the diet. Insufficiency or deficiency of vitamin D is commonly associated with osteoporosis.  Vitamin D can be produced by the body under the exposure of sunlight. However, even in Singapore where sunshine is abundant, only 92% post-menopause patients who had hip fractured were either deficient in vitamin D or has an insufficient level of vitamin D [4]. Reasons the low vitamin D levels are sedentary lifestyle and clothing habits which prevent exposure to sunlight. So, make sure to let your skin exposure to sunlight daily.

The production of vitamin D in the body requires sun exposure.

Post-menopausal women should always keep track of the vitamin D level in the body. Always ask for a 25-hydroxyvitamin D test during your routine blood test. Supplementation with vitamin D may be needed if you are not able to get enough exposure to the sun.

Calcium

Calcium is the major building block of the bone matrix. Calcium is also an essential nutrient that is needed for many other functions of the body including muscle functions, nerve transmission, intracellular signalling, hormonal secretion and more. 99% of the calcium in the body is stored in bone and teeth with the remaining 1% in blood serum [5]. When the body is low in calcium due to insufficient intake from the diet, the calcium in the bone will be released to ensure enough level of calcium in the blood to maintain essential body functions.

Kale is an excellent source of calcium, vitamin C, and K.

Calcium should be absorbed from the diet, not supplement as I have explained in my previous blog post (See DO YOU REALLY NEED CALCIUM SUPPLEMENTATION DURING MENOPAUSAL AGE?). To prevent leaching of calcium from bone, we should maintain a healthy dietary habit. Do not believe drinking milk alone can provide you with enough calcium for a strong bone as advertised in the television commercials. Research has shown that there is no evidence suggesting an association between milk consumption and the risk of hip fracture [6]. It is important to eat a variety of food that is rich in not only calcium, but also vitamin C, and K. Dark green vegetables including kale, spinach, turnip greens, bok choy, and broccoli are excellent sources of all the nutrients. They should be in your daily diet.

Conclusion

So, how to keep bone strong after menopause? Keep an active lifestyle, maintain a sufficient level of vitamin D, and eat a healthy diet rich in calcium are the three main strategies. There are no secret pills that can do the job.   

Eat a healthy diet rich in calcium – start from dark green vegetables.

References

[1]        C.T. Price, J.R. Langford, F.A. Liporace, Essential Nutrients for Bone Health and a Review of their Availability in the Average North American Diet., Open Orthop. J. 6 (2012) 143–9. doi:10.2174/1874325001206010143.

[2]        U.H. Lerner, Bone Remodeling in Post-menopausal Osteoporosis, J. Dent. Res. 85 (2006) 584–595. doi:10.1177/154405910608500703.

[3]        N. Mishra, V.N. Mishra, Devanshi, Exercise beyond menopause: Dos and Don’ts, J. Midlife. Health. 2 (2011) 51–56. doi:10.4103/0976-7800.92524.

[4]        R. Ramason, N. Selvaganapathi, N.H.B. Ismail, W.C. Wong, G.N. Rajamoney, M.S. Chong, Prevalence of vitamin d deficiency in patients with hip fracture seen in an orthogeriatric service in sunny singapore, Geriatr. Orthop. Surg. Rehabil. 5 (2014) 82–86. doi:10.1177/2151458514528952.

[5]        J.A. Beto, The role of calcium in human aging, Clin. Nutr. Res. 4 (2015) 1–8. doi:10.7762/cnr.2015.4.1.1.

[6]        S. Bian, J. Hu, K. Zhang, Y. Wang, M. Yu, J. Ma, Dairy product consumption and risk of hip fracture: a systematic review and meta-analysis, BMC Public Health. 18 (2018) 165. doi:10.1186/s12889-018-5041-5.

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