What is Osteopenia and Osteoporosis?
Osteopenia is reduced bone mass/thinning of the bone. This means there is less bone tissue inside your bones.
This can develop into a condition called Osteoporosis.
Osteoporosis is a condition affecting your bones where they lose strength. It causes low bone mass and the structure of the bone deteriorates. This makes the bone more fragile and increases the risk of having a fragility fracture - bones that break after falling from standing height or less.
What might cause Osteoporosis?
Your bone mass - the strength of your bone - is dependant on a number of factors:
- genetic factors
- levels of calcium and vitamin D
- sex hormone levels (these are androgens and oestrogen)
- your level of physical activity.
Peak bone mass is reached in your third decade of life, and starts to fall in the fifth decade for both women and men. This reduction in women increases after the menopause for between 5 to 10 years due to fall in oestrogen levels.
While bone loss is normal with ageing, there are other factors which can increase the rate of bone loss which leads to osteoporosis.
Is Menopause a risk factor for Osteoporosis?
Yes. Being female, increasing age and the menopause are all risk factors for developing osteoporosis.
Other factors which increase the risk of developing osteoporosis are smoking, alcohol, taking oral corticosteroids, low weight - having a BMI below 18.5, a parent having a hip fracture, previous fragility fracture and having a rheumatological condition such as rheumatoid arthritis.
Related: Get help with your menopause symptoms, treatment options and tips for keeping well in our dedicated Menopause resources area.
How is Osteoporosis diagnosed?
If you are found to have osteopenia on an x-ray, premature ovarian insufficiency or early menopause, a family history of osteoporosis or other risk factors such as low weight, your GP can do a risk calculation for Osteoporosis called a FRAX score.
You may be referred to have a bone scan called a DEXA scan - this uses a type of xray called dual energy X-ray absorptiometry (DEXA) to assess the density/strength of your bones in the lumbar spine and femur, thigh and determines whether you have osteoporosis.
What treatment is there for Osteoporosis?
Lifestyle factors (discussed later in this article) support medical treatment.
Osteoporosis can be treated with
HRT for Osteoporosis
Oestrogen levels fall in the menopause. Oestrogen helps to maintain bone density - this helps to strengthen the bone and prevent further bone loss, and therefore reduce the risk of fracture. When oestrogen levels fall, there is a risk of fracture.
HRT contains oestrogen which replaces the falling levels and therefore helps to maintain bone density. If you have not had a hysterectomy, you also need your HRT to contain progesterone to protect the lining of the uterus, the endometrium.
HRT can be used in a variety of ways - oestrogen and progesterone combined in a patch changed twice weekly, oestrogen patch/gel and progesterone tablet, oestrogen patch/gel and a mirena coil for the progesterone part or in a combined tablet.
HRT can be used as a treatment for osteoporosis as well as to treat menopausal symptoms.
Bisphosphonates for Osteoporosis
These drugs slow down the loss of bone and prevent further reduction in bone density. The most commonly used bisphosphonate is called Alendronic Acid (fosamax) It is taken once a week, usually for five years. There are other drugs in this group including risedronate and zolendronic acid.
What is the best treatment for my Osteoporosis?
Your Dr will discuss the different treatments with you and you can make a decision together about which is the best treatment for you.
Osteoporosis does not usually cause pain, however fractures can be painful. Please speak to your GP about pain relief for this, you can take paracetamol and ibuprofen (if safe for you to do so).
How can I prevent Osteoporosis? Top tips for prevention of Osteoporosis
This is important throughout life, and continues to be when you are peri- and post-menopausal.
Exercise should include a variety of different types including flexibility, balance, stretching, endurance and progressive strengthening exercises.
Related article: Tips for keeping fit and healthy in your 40s, 50s and beyond.
Weight bearing (standing so the weight of your body is pulling down on your skeleton) and bone strengthening exercises (using weights/bands/body weight) are important. This helps to keep your bones strong and strengthens your muscles.
Weight bearing exercise includes walking, running, jumping. It is recommended to do a combination of the 2, and ideally weight bearing exercise on most day and bone strengthening exercises 2-3 times a week on non consecutive days. This article includes some great advice about exercise for bones.
Following a healthy balanced diet with plenty of calcium
You should be having 700mg calcium a day.
Calcium provides strength to bones. There is calcium in dairy products, green leafy vegetables, dried fruit, tofu, almonds and sardines. You can check you are having enough calcium in your diet using the Edinburgh calcium calculator
If your levels are low, you should increase your calcium levels in your diet where possible. If needed, you can also take a calcium supplement such as calcium carbonate or calcium citrate.
Vitamin D helps your body absorb calcium and is important for bone and muscle strength.
You mainly get vitamin D from sunlight, there is also a small amount in fortified spreads such as margarine, oily fish, red meat, liver and egg yolks. Try and spend time outside whenever possible in the winter, ideally for at least 10 minutes once or twice a day.
In winter 2020 The UK government have recommended that everyone takes a 10microgram (400 international units IU) supplement through the winter to help supplement vitamin D levels.
Related article: A complete guide to Vitamin D
This helps to improve bone health. There is a higher rate of success of stopping smoking with support so speak to your Dr or nurse about this.
Drink alcohol within the recommended number of units
This is 14 units a week eg 175ml glass of wine is 2 units.
Maintain a healthy weight
Try to keep your weight in the healthy body mass index (BMI) range. This is a calculation using your weight and height to see if your weight is healthy. Normal BMI is 18.5-24.9,
What to do next about Osteoporosis
If you think you may be at risk of having osteoporosis, speak to your GP or gynaecologist about this and they can arrange investigations as needed.
There are also some excellent websites with a wealth of information including:
About the author:
Dr Rachel Hines is a GP and women's health specialist with a specialism in menopause. Find out more about Dr Hines in our directory.
Last updated: 5 February 2021