Bone Health and Menopause

During the menopause, women are at increased risk of osteoporosis. In our more recent blog posts we have shared what changes you can make to your diet to benefit your nutrition during menopause. This blog post will focus on the importance of bone health and menopause and what dietary changes you can make to protect your bones.

What is bone health and why is it important?

Bone tissue is alive and changes throughout our lives. We can promote bone health by eating well, staying active, and by following a healthy lifestyle [1]. It is important to keep our bones healthy as they have numerous important functions. They support our bodies, protect our organs and store minerals, such as calcium and phosphorus, to be released into the body when we need them. In later years, keeping bones healthy can prevent the risk of falls and fractures [2].

How does the menopause effect bone health?

As we age, our bone density decreases, leading to an increased risk of osteoporosis, where bones become weaker and are more likely to break [3]. Women going through menopause are at an even greater risk of osteoporosis, with research suggesting that up to 20% of bone loss can occur during menopause. Further research has shown that one in two postmenopausal women will experience osteoporosis, with fractures also occurring at this time. 

The reason for the decline in bone health in menopausal women is due to the drop in oestrogen, which is closely related to osteoporosis. When oestrogen levels decrease bone resorption occurs at a greater rate than bone formation, resulting in the development of osteoporosis [4]. 

How can you improve bone health?

There are several ways in which you can promote bone health during the menopause. Firstly, hormone replacement therapy (HRT) has been citied as an effective treatment to significantly increase bone mineral density. Studies show bone mineral density increases by 6.8%, 4.5%, and 4.1% at the lumbar spine, forearm, and femoral neck, respectively, following 2 years of treatment. However, HRT is not an option for all women due to conflicting medical conditions, therefore it is necessary to look for other options to improve bone health [4]. You may wish to discuss with your doctor whether HRT would be beneficial for you.

What nutrients can support bone health and menopause?

Adequate intake of nutrients plays an important role in improving bone health. Therefore, it is important that we consume enough foods containing nutrients such as calcium, protein, magnesium, phosphorus, vitamin D, potassium, and fluoride. An inadequate intake of these nutrients can lead to an increased risk of bone loss and osteoporosis. Eating a balanced diet containing at least 5 portions of fruit and vegetables a day, and a variety of protein sources, can contribute to our intake of these nutrients [5]. 

Calcium

Calcium is a nutrient of particular concern when discussing bone health. Around 99% of the body’s calcium is found in bones and it plays a big role in the structure of bones. The recommended daily intake of calcium is 700mg per day, for adults ages 19 to 64, and 2-3 calcium rich foods should be incorporated into the diet daily. Some good sources of calcium and their recommended portion sizes include milk (100ml); broccoli (85g); calcium set tofu (100g); cheese (30g or matchbox-size); plain yoghurt (120g); kale (100g); wholemeal bread (100g); calcium-fortified plant-based milk alternative (100ml); and sardines (60g) [6]. Calcium supplementation in the diets of post-menopausal women had been shown to slow the rate of bone mineral density lost over a 1-2 year period, reinforcing the importance of an adequate calcium intake [7].

Phosphorus

Additionally, an adequate intake of phosphorus is important for maintaining bone health. Phosphorus is converted to phosphate in the body to be used for bone growth and mineralisation. A lack of phosphate in the body can lead to the development of rickets and osteomalacia, or bone softening [8]. Adults need 550mg of phosphorus a day, which can be found in foods such as red meat; dairy; fish; poultry; bread; oats; and brown rice [9]. However, it is important that an excessive intake of phosphorus is avoided as this can have adverse effects on bone health [10].

Magnesium

Another nutrient of concern when discussing menopause and bone health is magnesium. One study found that low magnesium intakes correlated with a low bone mineral content in post-menopausal women [11]. Magnesium deficiency is said to contribute to osteoporosis by inhibiting crystal formation in bone cells, therefore an adequate intake of magnesium is suggested [12]. The recommended daily intake of magnesium for women aged 19 to 64 years is 270mg per day. Good sources of magnesium include spinach, nuts, and wholemeal bread [13].

Vitamin D

Finally, in relation to calcium and phosphate, vitamin D is additionally a nutrient of concern for menopausal women. Vitamin D helps to regulate the amount of calcium and phosphate in the body, essential nutrients for bone health [14]. Furthermore, vitamin D increases the absorption of calcium, leading to a decreased risk of fracture. However, both vitamin D and calcium levels must be adequate for this to be true [15]. The recommended intake of vitamin D for adults is 10 micrograms per day, this can be taken in through the diet through oily fish; red meat; liver; egg yolks; and fortified foods. Vitamin D supplementation is often recommended for everyone during the autumn and winter months as the sun is not strong enough for the body to make vitamin D. However, some people at risk of vitamin D deficiency, such as people who work indoors, people who cover their skin outside, or people who have dark skin, may benefit from a vitamin D supplement year-round [16].

Top Tips for Bone Health and Menopause

  1. If HRT works for you, it can be an effective way to prevents reductions in bone mineral density.
  2. Ensure you are eating a variety of fruit and vegetables, and protein sources, as part of a balanced diet to help meet your nutrient requirements.
  3. Eat 2-3 calcium-rich foods per day to slow the rate of bone mineral density loss.
  4. Ensure you are meeting your daily requirements for phosphorus and magnesium intake to promote bone health and decrease the risk of developing osteoporosis.
  5. Consider taking a vitamin D supplement during the winter, or if you are at risk of vitamin D deficiency to ensure that your body is absorbing calcium and phosphorus effectively.

References 

[1] https://theros.org.uk/information-and-support/bone-health/ 

[2] https://www.nhs.uk/live-well/bone-health/keep-your-bones-strong-over-65/ 

[3] https://www.endocrine.org/patient-engagement/endocrine-library/menopause-and-bone-loss 

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5643776/ 

[5]https://pubmed.ncbi.nlm.nih.gov/17092827/#:~:text=Inadequate%20intake%20of%20nutrients%20important,D%2C%20potassium%2C%20and%20fluoride

[6] https://www.nhs.uk/conditions/vitamins-and-minerals/calcium/ 

[7] https://pubmed.ncbi.nlm.nih.gov/15018485/ 

[8]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3461213/#:~:text=The%20presence%20of%20phosphate%20is,and%20bone%2C%20involving%20multiple%20regulators.

[9] https://www.nhs.uk/conditions/vitamins-and-minerals/others/

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693714/ 

[11] https://pubmed.ncbi.nlm.nih.gov/8059619/

[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775240/

[13] https://www.nhs.uk/conditions/vitamins-and-minerals/others/

[14]https://pubmed.ncbi.nlm.nih.gov/17913228/#:~:text=Calcium%20is%20required%20for%20normal,calcium%20homeostasis%20and%20skeletal%20integrity.

[15] https://pubmed.ncbi.nlm.nih.gov/31860103/ 

[16] https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/

Caroline Hill, Dietitian and owner of Caroline Hill Nutrition

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