Bone Health 101 Part II

Of the estimated 10 million Americans with osteoporosis, about 80% are women. An additional 27.3 million women have osteopenia a precursor to osteoporosis. Approximately one in two women over age 50 will break a bone because of osteoporosis.  Osteoporosis is called the “silent disease” because until a bone is broken, people are generally unaware they have it. Osteoporosis is the main cause of fractures in postmenopausal women (average age 55+). 

Osteoporosis is a systemic skeletal disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased risk of fracture. Women have a greater lifetime fracture risk (40%) than men (13%) due to their typically smaller, thinner bones. Women also tend to lose bone at a younger age and at a quicker pace than men (4). Additionally, estrogen plays a critical role in bone development, and it begins declining as women enter perimenopause, creating a significantly higher risk for osteoporosis in postmenopause. Decrease in bone density is particularly fast in the 5-10 years around the menopause transition due to loss of the protective effect of estrogen. During that rapid bone loss, the delicate structure (microarchitecture) of the skeleton is damaged, weakening the bone and predisposing to a fracture (a “bone attack”). This is the critical window to protect bones. 

This means that we must begin taking our bone health seriously in perimenopause (or before). Your state of health as you enter into menopause correlates with your health and longevity postmenopause. It is the last chance you have to enhance bone health or to reverse any damage. You can minimize future damage but not restore back without pharmacologic intervention. 

Check out our interview with Dr. Patricia Mills on Bone & Muscle Health.

References

1. https://choosingwiselycanada.org/wp-content/uploads/2017/05/DEXA-EN.pdf

2. Chidi-Ogbolu N, Baar K. Effect of Estrogen on Musculoskeletal Performance and Injury Risk. Front Physiol. 2019 Jan 15;9:1834. doi: 10.3389/fphys.2018.01834. PMID: 30697162; PMCID: PMC6341375.

3. Perry SD, Bombardier E, Radtke A, Tiidus PM. Hormone replacement and strength training positively influence balance during gait in post-menopausal females: a pilot study. J Sports Sci Med. 2005 Dec 1;4(4):372-81. PMID: 24501551; PMCID: PMC3899653.

4. Melton LJ 3rd, Chrischilles EA, Cooper C, Lane AW, Riggs BL. Perspective. How many women have osteoporosis? J Bone Miner Res. 1992 Sep;7(9):1005-10. doi: 10.1002/jbmr.5650070902. PMID: 1414493.

5. Hansen D, Pelizzari P, Pyenson B. Medicare Cost of Osteoporotic Fractures-2021 Updated Report. Milliman, Inc.: Seattle, WA, 2021.

6. McPhee C, Aninye IO, Horan L. Recommendations for Improving Women's Bone Health Throughout the Lifespan. J Womens Health (Larchmt). 2022 Dec;31(12):1671-1676. doi: 10.1089/jwh.2022.0361. Epub 2022 Nov 7. PMID: 36346282; PMCID: PMC9805882.

7. LeBoff MS, Greenspan SL, Insogna KL, et al. The clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int 2022;33(10):2049–2102

8. US Preventive Services Task Force, Curry SJ, Krist AH, et al. Screening for osteoporosis to prevent fractures: US Preventive Services Task Force recommendation statement. JAMA 2018;319(24):2521–2531.

9. Snow CM, Shaw JM, Winters KM, Witzke KA. Long-term exercise using weighted vests prevents hip bone loss in postmenopausal women. J Gerontol A Biol Sci Med Sci. 2000 Sep;55(9):M489-91. doi: 10.1093/gerona/55.9.m489. PMID: 10995045.

10. Shaw JM, Snow CM. Weighted vest exercise improves indices of fall risk in older women. J Gerontol A Biol Sci Med Sci. 1998 Jan;53(1):M53-8. doi: 10.1093/gerona/53a.1.m53. PMID: 9467434.

11. https://www.jospt.org/doi/10.2519/jospt.2015.4842 

12. Clark D, Nakamura M, Miclau T, Marcucio R. Effects of Aging on Fracture Healing. Curr Osteoporos Rep. 2017 Dec;15(6):601-608. doi: 10.1007/s11914-017-0413-9. PMID: 29143915; PMCID: PMC6517062.

13. https://osteoporosis.ca/medical-conditions-that-can-cause-bone-loss-falls-and-or-fractures/ 

14. Rondanelli M, Faliva MA, Tartara A, Gasparri C, Perna S, Infantino V, Riva A, Petrangolini G, Peroni G. An update on magnesium and bone health. Biometals. 2021 Aug;34(4):715-736. doi: 10.1007/s10534-021-00305-0. Epub 2021 May 6. PMID: 33959846; PMCID: PMC8313472.

15. Sharma T, Mandal CC. Omega-3 fatty acids in pathological calcification and bone health. J Food Biochem. 2020 Aug;44(8):e13333. doi: 10.1111/jfbc.13333. Epub 2020 Jun 17. PMID: 32548903.

16. Orchard TS, Pan X, Cheek F, Ing SW, Jackson RD. A systematic review of omega-3 fatty acids and osteoporosis. Br J Nutr. 2012 Jun;107 Suppl 2(0 2):S253-60. doi: 10.1017/S0007114512001638. PMID: 22591899; PMCID: PMC3899785.

17. https://www.sciencedirect.com/science/article/abs/pii/S1551714415000191

18. König D, Oesser S, Scharla S, Zdzieblik D, Gollhofer A. Specific Collagen Peptides Improve Bone Mineral Density and Bone Markers in Postmenopausal Women-A Randomized Controlled Study. Nutrients. 2018 Jan 16;10(1):97. doi: 10.3390/nu10010097. PMID: 29337906; PMCID: PMC5793325.