Surviving menopause: Osteoporosis, Calcium and Vitamin D


As menopause approaches, many women begin to worry about osteoporosis and how to prevent it.
This is something to be concerned about because the drop in estrogen production which occur after menopause causes an increase in bone loss leading to fragile bones.

Factors which increase the risk of developing osteoporosis include:

  1. low bone density (thickness of your bones) at the time of menopause
  2. smoking
  3. premature menopause
  4. removal of the ovaries and uterus
  5. drugs (e.g. some asthma medications)

After menopause, bone loss is almost inevitable, so at this point, you’re trying to reduce the rate at which it is lost, and if possible reverse the loss.
The WHI (Women’s Health Initiative) trials on the effects of hormone replacement therapy also included a trial on the effects of Calcium and Vitamin D supplementation on:

  1. the risks of suffering hip fractures and other fractures which are strongly associated with osteoporosis,
  2. bone density and
  3. the risk of getting colorectal cancer.

The 36,252 women who chose to take part in the Calcium/Vitamin D (CaD) trial were randomly assigned to two groups:

  • one group taking a pill containing 500mg of Calcium and 200IU (IU =international units) of Vitamin D twice a day (a total of 1000mg of Calcium and 400IU of Vitamin D daily)
  • the other group receiving an inactive placebo.

Overall:

  1. women taking CaD had 12% fewer hip fractures
  2. they had slightly fewer fractures overall but the difference was not significant
  3. women who took their pills regularly had 29% fewer fractures than the placebo group
  4. women 60 years and over had a 21% decreased risk of hip fracture compared to women over 60 in the placebo group
  5. women on CaD had slightly increased bone density
  6. they also 17% more kidney stones
  7. there was no difference in the occurrence of colorectal cancer between the two groups

It is important to note that many of the women enrolled in the CaD trial already had a lower risk of developing hip fractures than women in the general population because:

  1. most were on hormone replacement therapy which reduces the risk of developing osteoporosis
  2. many already had a high personal intake of Calcium and Vitamin D
  3. most had higher than average weight which also tends to reduce risk

These observations may explain the fact that there wasn’t much difference overall between the two groups. It is possible that differences may be greater in women who are not on hormone replacement therapy.

What does this mean for women worried about osteoporosis

  1. Women over 50 should take a total of 1000 – 1200mg of Calcium and 400 – 600IU of Vitamin D a day.
  2. Calcium and vitamin D are more effective when they are taken regularly.
  3. Lifestyle changes that can help include :
    • eating a low fat, high fibre diet
    • carrying out weight-bearing exercise (e.g. walking and climbing stairs). The benefits of exercise aren’t limited to helping to reduce bone loss. Women who exercise have better posture and balance and are less likely to fall in the first place and so tend to have fewer fractures.

Red and yellow fruit for bone health

osteoporosis, bone loss, bone healthYou may know about getting enough calcium to help protect your bones from osteoporosis and keep them healthy. Keeping your bones healthy takes a bit more than that. There are many things that contribute to taking care of your bones as you get older.

Eating lots of red and orange fruit and vegetables may help to protect your bones. Red and orange fruit and vegetables contain large amounts of a substances called carotenoids. A study published in the American Journal of Clinical Nutrition found that eating more carotenoids (especially one called lycopene) may maintain bone density in women. They found that women who ate lots of food rich in lycopene had less hip and lumbar bone loss than women who didn’t.

To get these benefits, fill up on cooked tomatoes, watermelon and pink and red grapefruit which are the richest sources of lycopene.

Better to have breast cancer than a hip fracture?

breast cancer, hip fracture, osteoporosisWomen over 65 are more likely to die if they have a hip fracture than if they are diagnosed with breast cancer. This finding was presented by a team of investigators at the American Geriatric Society’s annual meeting.
In the study, women who had hip fractures tended to be older, better educated, have lower BMI (body mass index) i.e. they weren’t as heavy, decreased mental state and less weight changes since the age of 25 years than women with breast cancer.
Even after making adjustments for all these factors and a few others, the women with breast cancer still survived longer than those with hip fractures.

Hip fractures occur more frequently in older women who tend to have greater degree of osteoporosis. These findings reinforce the need to take osteoporosis prevention very seriously. Even after developing osteoporosis which is associated with the onset of menopause, women should be encouraged to take measures that can help reduce the severity of osteoporosis and the risk of having a hip fracture. A good example of one of these measures is weight-bearing exercise which increases muscle strength, coordination and flexibility which in turn would reduce the number of falls.

One tablet a month could help osteoporosis after menopause

One tablet (150mg) of the drug ibandronate (Boniva) a month could help women with postmenopausal osteoporosis. Boniva is related to the drugs Fosamax and Actonel both of which are available to be taken by mouth daily or weekly. All these are all drugs which help to prevent and treat osteoporosis after menopause. Boniva can be taken daily but is the only medication on the group that can be taken monthly.

Research has shown that taking Boniva once a month by mouth was as effective as weekly Fosamax or Actonel in reducing fractures in women with osteoporosis after menopause.The study was carried out in 93 postmenopausal women aged 55-85.

This may not seem like a big deal but it definitely makes life easier in terms of the number of pills you have to take and remembering to take your medication. This is good news for members of the “I hate taking tablets” brigade (including yours truly!).

Dried plums to prevent osteoporosis and fractures

osteoporosis, fractures, menopause, calcium, vitamin DCan a handful of dried plums (prunes) save you from a long stay in hospital?
Osteoporosis makes the bones fragile so they fracture easily with very little force or stress. In the first 7 years after menopause, women can lose up to 5% of their bone mass every year. About 8 million women have osteoporosis after menopause in the United States and about 2 million men. After the age of 65, men begin to lose bone mass just as fast as women do.

So where do prunes come into the picture? A recent study has shown that eating dried prunes can increase bone density in postmenopausal women.

Over a 12 month period 2 groups of women were told to take 500mg of calcium and 400i.u. of vitamin D every day. In addition, one group was asked to take 100mg of dried plums and the other 100mg of dried apples every day. At the end of the study the bone mineral density in the ulna (one of the forearm bones) and the bones of the spine were noticeably higher in the women who had taken the dried plums.

Your bones are constantly changing. As bone is being produced in the body it is also being broken down and being reabsorbed. The density of the bone depends on the balance between production and resorption. The rate at which bone is reabsorbed increases with age. Dried prunes act by slowing down the rate at which bone is broken down in the body. This makes it easier to the bones to become stronger and less likely to fracture. About 6-10 dried plums should be eaten every day to achieve this effect.

As advised by the lead researcher, you don’t have to wait until you’re diagnosed with osteoporosis to start eating prunes. You can start out with 3 or 4 a day and gradually work up to 6-10 a day. Don’t forget your calcium and vitamin D which are also important in maintaining good bone health.

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