Protecting our bones through menopause and beyond.
As part of our Lunch & Learn webinar series, we were joined by Dr Shahzadi Harper of The Harper Clinic.
In this session, we discussed how menopause can affect long-term health, in particular bone health, and what you can do about it.
Henpicked: Why do we need to think about our bone health as we reach menopause?
Dr Shahzadi Harper: For most women, as we enter into our 40s, our hormones start to change. Our ovaries, which produce oestrogen and progesterone, are producing less and less and these hormone levels are fluctuating. We hear about perimenopause symptoms such as hot flushes, not sleeping, and being moody, but we sometimes forget about the protective aspects of our hormones for our long-term health. Bone health is important as oestrogen is responsible for forming our bone cells. As we go into late perimenopause, menopause and post menopause, because the level of oestrogen declines our bone mineral density weakens and we become more prone to fractures.
I sometimes liken our bones to a Crunchie bar, with honeycomb in the middle and chocolate on the outside. As our oestrogen levels decline the holes in the honeycomb widen and the chocolate on the outside becomes thinner. This makes us more prone to a fracture as our bones weaken during menopause transition.
Henpicked: This can be hard to spot as we can’t see our bones, can’t it?
Dr Shahzadi Harper: Osteoporosis, bone disease, is often called the silent disease as the first time you know what’s going on is when you have a fracture. But there are warning signs or people who may be more prone. Those who have early menopause have lost the protective effect of oestrogen earlier on. We stop forming bone from age 30. It stays steady for a while because of our hormones, but as our hormones drop so does bone mineral density.
A family history of osteoporosis may make you more prone, and smokers and heavy drinkers have more fragile bones. If you’ve had gastric issues like Crohn’s disease, colitis, or had bariatric surgery for weight loss, you could find you’re not absorbing calcium and vitamin D from your diet as well as you could.
And you could be experiencing this without knowing what’s going on until the first fracture.
Henpicked: What preventative measures can we take?
Dr Shahzadi Harper: It’s important to understand that women can lose up to 50% of bone structure in the first 10 years after menopause. So it’s a really good time to look to your lifestyle. Calcium intake is very important – aim for 2-3 portions a day. Dairy is the best source but if you’re following a dairy-free diet try things like fortified milk and canned fish like sardines and salmon. These are particularly good if they still have bones in. Almonds are also very good. The recommended calcium levels are 1,300g for post-menopausal women and 1,000g for pre-menopausal women.
We also need to look to our vitamin D intake, as this helps to form bones. We get this from daylight or you can supplement all year round.
And exercise is really important. We want weight-bearing movements, that put shock waves through your bones. Think running, jogging, tennis, dancing – these will help to strengthen your bones. Think of movement as a prescribed medication to take every day and incorporate into your life. Even simple things like standing on one leg, then the other when making a cup of tea, simple squats waiting for kettle to boil. Tiny things to fit into your daily life and over time these will add up for you.
Muscle mass can help to strengthen and protect our joints, so it’s all interconnected. Exercise is good for the brain, too.
Henpicked: What influence could HRT have on bone health?
Dr Shahzadi Harper: We talk about losing bone strength and density because of losing hormones, so it makes sense that adding back hormones can help rebuild your bone or prevent it breaking down or weakening. HRT is a good way of maintaining bone health and preventing osteoporosis. It can also manage acute symptoms like night sweats and hot flushes, but one of the long-term benefits is that oestrogen helps bone make more cells to keep its strength.
Henpicked: Is it ever too late to go on HRT for these long-term benefits?
Dr Shahzadi Harper: It’s never too late. Most women under 60 can go onto HRT and over 65 you may just need a lower dose. It can add a lot of long-term benefits, especially from a bone point of view, but can also be beneficial for heart and brain health.
Henpicked: Is there a test to see what our bone density is?
Dr Shahzadi Harper: Yes, it’s called a DEXA scan. You need to be referred by GP and there are certain criteria for a scan on the NHS, such as family history, a fragility fracture with no apparent cause, taking progesterone-only contraception, if you’re a smoker or excessive drinker, or if you had early or surgical menopause. The machine measures your bone density using a ‘Z score’. If this is under -2.5 it will put you into the osteoporosis category. Between -1 and -2.5 puts you into the osteopenia category. This means you have weakened bones but not osteoporosis. It can be a good time to then look at your nutrition and exercise.
Osteoporosis, however, may need treating with medication. HRT may be considered, bisphosphonates, or six-monthly injections which can strengthen the bones.
I’d recommend you wait at least 12 months for another scan to check out if these interventions are working.
Henpicked: In your view, are GPs open to talking about bone health?
Dr Shahzadi Harper: Yes, they are quite aware of osteoporosis and the role of menopause, but they are constrained by guidelines and can’t just refer everyone for a scan. Preparation is everything when talking to your GP, look at your symptoms, keep a diary, make a list, understand what outcome you would like. This is especially important if you’re struggling with brain fog, as it will help you get the best out of your appointment.
Dr Shahzadi Harper is an innovative doctor interested in optimising women’s wellbeing and health and empowering them to look and feel their best. She looks after women of all backgrounds and ethnicities enabling them to make informed choices for their optimal health. She has an understanding of the symptoms and concerns that women face as she herself is one of six sisters and has a grown up daughter.
Her areas of expertise include Perimenopause and Menopause, Polycystic Ovarian Syndrome, Premenstrual Stress disorder, Healthy Ageing and Weight Management.