In this blog, QSMC Sports and Exercise Physiotherapist Jacinta Carroll explores the connection between peri-menopause, menopause, and osteoporosis, while also discussing practical strategies to promote overall well-being and bone strength.
Menopause and Osteoporosis: What is it and what can we do about it?
Peri-menopause and menopause are stages in a female’s life where a multitude of hormonal changes occur within the female body. Unfortunately, many of these hormonal changes can result in physical symptoms that each individual must face and overcome.
Peri-menopause vs Menopause
Peri-menopause: variables in menses, however menses are still present
Early Peri-menopause: menses that occurred in the proceeding 3 months, however, does have variability
Late Peri-menopause: no menses within the previous 3 months however menses has occurred with variability in the preceding 4-12 months
Menopause: the complete cessation of the menstrual cycle for greater than 12 months
Osteoporosis
Osteoporosis is a condition that results in a decrease in bone mineral density, bone mass, and/or structural changes within a bone. Ultimately, osteoporosis is a silent condition whereby the bone becomes progressively weaker until the point of fracture. Only then will it become evident that this condition has been lingering in the background for quite some time.
Bones are constantly being remodeled within the human body. As load is applied to the body through impact loading or muscle strain, our bones respond by forming microcracks from these forces (this is normal). These microcracks will stimulate cells known as osteoclasts to come in and clear away this “weakened” area of the bone. This process then activates and stimulates another cell (osteoblasts) to come in and help remodel new bone. This whole process is in part regulated by the hormone oestrogen. Oestrogen inhibits the cells which clear away bone (osteoclasts) from doing too much, controlling these cells to prevent the resorption of bone structure.
During peri-menopause there is a decrease in ovarian-derived oestrogen, reducing the amount of oestrogen to act on the osteoclasts (bone-resorbing cells). As a result, we begin to have a mismatch in the amount of bone being resorbed by osteoclasts and the amount of bone generative by osteoblasts. This mismatch often becomes exacerbated when we reach menopause and have a complete lack of ovarian-derived oestrogen production. As bone is now getting resorbed faster than it is being generated, we begin to see a decrease in bone mineral density.
One in two females who experience menopause will encounter osteoporosis as a secondary condition. I’m here today to tell you not to panic as there are options out there to help decrease the likelihood of experiencing osteoporosis as well as mitigate the effects of bone mineral density decline as we age.
What can we do about it?
From a health and medical perspective, medication, vitamins, supplements, injections, and nutritional interventions have been found to slow the decline in bone mineral density.
From a physical health perspective, strength training is one method of intervention that stimulates bone remodeling. Evidence supports completing high-intensity resistance training to stimulate bone remodeling can result in a decreased loss of bone mineral density. Unfortunately, low-level exercises including bodyweight exercises performed 30 minutes a day for 8 months, can still result in bone mineral density declines. When comparing high-intensity resistance training to bodyweight exercises, ladies who completed high-intensity loading had only an 18.6% decrease in bone mineral density compared to 72.1% in those doing body weight exercises and walking.
High-intensity resistance training may also improve physical performance tests such as back extension strength, leg extension strength, functional reach test, sit-to-stand test, and vertical jump test. Improvements in all of these tests also correlate to a decrease in fall risk, ultimately reducing the likelihood of an osteoporotic fracture from falling.
The high-intensity resistance training found to be most effective in decreasing the decline in bone mineral density includes lifting heavy weights at around 80% of the patients’ maximum capacity as well as completing impact loading. All of these exercises, however, should be performed under supervision and taught correctly to make sure you are completing these exercises safely to benefit your skeleton rather than potentially risking further injury.
