Many of us think osteoporosis affects only "old people" and this is often exemplified by images of brittle, curved old ladies holding on to a walker.
It doesn't help that our US Department of Health and Human Services recommends bone density screening beginning at age 65. It's a silent message that we don't need to worry about it until then.
But that might be too late for many women, who account for 80% of all cases of osteoporosis and have a 1 in 3 risk of developing it in their lifetime.
In fact, research indicates that screening recommendations should start earlier. In 2019, a study of 173 men and women between the ages of 35 and 50 published in the Journal of Osteopathic Medicine reported that 26% of the women had osteopenia or low bone mineral density – an indication of the start of osteoporosis.
What is osteoporosis?
Osteoporosis is a medical condition when the bones literally become "porous" and less dense, increasing their weakness and risk for breakage. The leading cause of osteoporosis in women originates from the decrease in levels of estrogen (after menopause) and deficiencies of calcium or vitamin D, as the bone was forming until 30 years of age.
Osteopenia is just the beginning phase of osteoporosis and indicates hazards ahead. We can lose up to 20% of our bone density during the first five to seven years following menopause. This is actually the time of most bone loss in a woman's life when after that, the loss is more gradual.
Until the age of 30, we have our peak bone density mass, and after that, we cannot build any more bone. We need to keep what we have and make sure that our skeleton is strong and resilient through perimenopause, menopause, and beyond.
That is why perimenopause is a crucial time to care for our bone health.
Risks Factors
Genetics
Genetics has a significant role in your risk of osteoporosis. If your mother and grandmother had osteoporosis, you also have a higher risk of developing it. I recommend getting a DEXA scan which will determine your bone density.
History of RED-S (AKA Athlete's Triad)
RED'S stands for relative energy deficiency in sport, and it's characterized by amenorrhea or when you stop menstruation. This signals that hormonal health is imbalanced, and there's a high risk of undernutrition and bone loss.
Poor nutritional status
Deficiency in calcium, vitamin D and/or magnesium affects bone health. Dietary restrictions (either total calories or foods rich in those nutrients) can cause long-term health consequences, including lower bone density.
Low body weight
Having a low body weight is an increased risk factor for developing osteoporosis.
What can you do to prevent bone loss during and after perimenopause?
1. Increase exercises that will stress your bones
Bones are living tissues that will respond to stress by getting stronger, so exercises that create bone stress will benefit bone health. Weight-bearing exercises or exercises that will put some form of impact or make resistance to force will stimulate the body and the bone tissue formation.
Examples are weight lifting, jump rope, climbing stairs, tennis, and jogging/running.
The American College of Sports Medicine recommends at least 30 minutes of weight-bearing activity three to five times a week and resistance training two to three times a week as well as multidirectional exercises (plyometrics) like tennis, jumping in different directions are examples of types of ideal exercises for promoting bone density.
2.Get your nutrition on point for bone health
First and foremost, if you are not eating enough nutrients, your bone health will be compromised, so getting enough calories is very important.
Calcium
Calcium is the most essential mineral for skeletal health women ages 19 to 50 should consume 1000 milligrams of calcium per day, and women over the age of 51 should consume 1200 milligrams of calcium per day.
It's important to know that calcium is a very "picky" mineral in its absorption rate. For example, we can digest only 20% of the calcium from plant foods. So, in other words, we should be intentional about having foods rich in calcium all our lives: as bone develops before our 30's and as we hope to maintain what we have after our 40's.
Here are some examples of calcium-rich foods:
Another important detail is that calcium is better absorbed throughout the day, so taking a single calcium supplement of 1200 milligrams is not recommended. It can be harmful as it may cause adverse effects in some people.
Vitamin D
Vitamin D is essential for bone health, and I recommend supplementing it in drops because it is hard to get all the recommended dietary intake from foods.
Here are some vitamin D information:
Magnesium
Almost half of the US population is deficient in magnesium according to the latest NHANES – National Health and Nutrition Examination Survey, even though it is a nutrient that is highly available in various sources of wholesome foods, as indicated below:
Summary
Perimenopausal women should start thinking about their bone health. It's important to understand that estrogen is crucial in maintaining bone formation. After menopause, when our estrogen production is drastically reduced, we are at a greater risk for bone loss.
Considering other factors that might play a role in bone health is important when prioritizing it. If you have one or more risk factors, you should start taking care of your nutrition and incorporating bone-promoting exercises to prevent as much bone loss as possible so you can live a long, vibrant and functional life.