What to Know About Postmenopausal Osteoporosis

Symptoms of postmenopausal osteoporosis

Osteoporosis typically doesn’t cause symptoms until the condition has advanced. However, people with osteoporosis have a higher risk for fractures or broken bones, and symptoms of these fractures may include:

• back pain
• decreased mobility
• fractures (bone breaks) in your back, wrists, or hips
• changes in posture, such as kyphosis (forward curve of the spine)
• a decrease in height

Many people don’t know they have osteoporosis until they experience a bone fracture. Regular screenings after postmenopause, which occurs when you haven’t had a menstrual period for 12 consecutive months, can help you understand your risk.

Causes and risk factors for postmenopausal osteoporosis

Postmenopausal osteoporosis occurs when bones begin to break down more rapidly than usual as a result of lower estrogen levels.

The body is constantly breaking down and rebuilding bone, but estrogen usually slows the breakdown process. As estrogen levels decline during the menopausal transition, the bones break down faster than they can rebuild, making them less dense and weaker.

The risk of developing osteoporosis may increase even more with time. The longer that you’re exposed to lower estrogen levels related to menopause, the more your osteoporosis risk goes up.

Other risk factors

Though menopause is a strong risk factor for osteoporosis, others exist as well. Additional osteoporosis risk factors include:

• increasing age
• eating a diet high in processed food and lacking a variety of vitamins and minerals
• regularly drinking high amounts of alcohol
• smoking
• having a family history of bone fractures
• taking certain medications, like glucocorticoids
• having certain other medical conditions, like rheumatoid arthritis or diabetes
• having a lower body weight

Though some of these factors can’t be changed, it’s important to know how they affect your osteoporosis risks. If you have any of these risk factors, discuss them with your doctor as you go through menopause.

Diagnosing postmenopausal osteoporosis

Doctors diagnose osteoporosis by estimating bone mineral density. Your bones’ density is one of the things that makes them strong and resilient to breaking.

Doctors can measure bone density with a few types of scans. One is called a dual-energy X-ray absorptiometry (DEXA) scan, which uses X-rays to evaluate parts of your body that may have a higher fracture risk.

Based on your DEXA scan results, doctors can estimate your bone density and your fracture risk.

A quantitative computed tomography (QCT) scan may also be helpful, but it’s less commonly used. This scan uses X-rays to make a 3D image of your bones.

If your doctor diagnoses postmenopausal osteoporosis, you’ll likely need to get regular scans to determine if your treatment is working. Ask your doctor about the best screening regimen for you.

Once you’ve gotten a diagnosis, you may need or want to see a specialist who can help manage osteoporosis and prevent complications.

Medical treatments for postmenopausal osteoporosis

Many medications can help promote bone growth and stability and reduce how quickly bone breaks down. A doctor will consider your overall health, osteoporosis risk, and potential side effects when determining what medication to prescribe.

Medications a doctor may prescribe to treat osteoporosis include the following:

Bisphosphonates

Bisphosphonates help manage postmenopausal osteoporosis by reducing the rate of bone loss. Examples of these medications include:

• alendronate (Fosamax)
• zoledronic acid (Reclast)
• risedronate (Actonel)

Denosumab

Denosumab (Prolia) is an injectable medication that helps reduce your risk of fractures by keeping your bones from breaking down too fast. It may be a good alternative for people who can’t take bisphosphonates.

Abaloparatide

Abaloparatide (Tymlos) is an injection that doctors prescribe for people who have a high risk of osteoporosis fractures. The medication helps reduce the risk of spine fractures and other bone fractures, but you can’t usually take it for more than 2 years.

Romosozumab

This injectable medication, available under the brand name Evenity, helps slow bone loss and stimulate bone formation. Doctors usually prescribe it for those who are at very high risk for postmenopausal fractures.

Calcitonin

Calcitonin is a hormone naturally found in the body that can help control calcium levels and also prevent bone loss. If you are at least 5 years past menopause, you may be able to take calcitonin via a nasal spray.

Lifestyle changes for postmenopausal osteoporosis

In addition to medications, certain lifestyle changes may help you maintain your bone health, including:

• eating a diet that contains sufficient amounts of calcium and vitamin D
• engaging in regular weight-bearing activities, such as exercises using resistance bands or even just walking
• maintaining a moderate weight to reduce stress on your bones
• avoiding habits that may contribute to bone loss, such as smoking or drinking high amounts of alcohol

Your doctor may also recommend taking calcium and vitamin D supplements to encourage the formation of new bone. If you need help figuring out the right balance between taking supplements and including more vitamin- and mineral-rich foods in your diet, a registered dietitian with experience managing osteoporosis can help.

Takeaway

Menopause causes a decline in estrogen levels that can increase your risk of developing osteoporosis. Medications and lifestyle changes can help you protect your bones and reduce your risk of fractures.

If you are nearing menopause or have gone through menopause, talk with your doctor about your risks and how to reduce them.